Docstoc

MHR COVER Page 070109

Document Sample
MHR COVER Page 070109 Powered By Docstoc
					    MENTAL HEALTH
REHABILITATION SERVICES
   PROVIDER MANUAL
    Chapter Thirty-One of the Medicaid
             Services Manual


           Issued April 1, 2009




                    State of Louisiana
                    Bureau of Health Services Financing
LOUISIANA MEDICAID PROGRAM        ISSUED:                        03/01/11
                                 REPLACED:                       04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                                    PAGE(S) 7


             MENTAL HEALTH REHABILITATION (MHR)

                             TABLE OF CONTENTS

SUBJECT                                                       SECTION

OVERVIEW                                                 SECTION 31.0
  MHR Program Services Package
     Covered Services
           Mandatory Services
           Optional Services
  Screening for Medical Necessity
     Medical Necessity Criteria
           Adult Criteria for Services
           Children/Youth Criteria for Services
     Exclusionary Criteria
     Discharge Criteria


SERVICES                                                 SECTION 31.1
  Services Delivery
  Mandatory Services
     Assessment and Service Planning
           Service Definition
           Program Requirements
     Service Planning
           Goals
           Objectives
           Interventions
           Individualized/Recovery Focused Crisis Plan
           Discharged Plans
     Staffing Requirements
           Service Specific Documentation Requirements
           Service Authorization Periods




                                  Page 1 of 7             Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:                           03/01/11
                                 REPLACED:                          04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                                       PAGE(S) 7

SUBJECT                                                           SECTION

    Community Support
          Service Definition
          Program Requirements
          Place of Service and Frequency of Contact
          Staffing Requirements
          Service Authorization Periods
    Group Counseling
          Service Definition
          Clinical Exclusions
          Program Requirements
          Place of Service
          Staffing Requirements
          Service Authorization Periods and Service Limits
    Individual Intervention
          Service Definition
          Place of Service
          Staffing Requirements
          Service Authorization Periods
    Medication Management
          Service Definition
          Program Requirements
          Storage of Medications
          Staffing Requirements
          Service Specific Documentation Requirements
          Place of Service
          Service Authorization Periods
    Parent/Family Intervention (Counseling)
          Service Definition
          Program Requirements
          Place of Service
          Staffing Requirements
          Service Authorization Periods
    Psychosocial Skills Training-Group (Youth)
          Service Definition
          Clinical Exclusions
          Program Requirements
          Place of Service
          Staffing Requirements
          Service Authorization Periods
          Optional Services

                                Page 2 of 7                  Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:                              03/01/11
                                 REPLACED:                             04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                                        PAGE(S) 7

SUBJECT                                                               SECTION
Mandatory Services (cont’d)
     Parent/Family Intervention (Intensive) (Youth Only)
           Service Definition
           Program Requirements
           Duration of Treatment
           Intensity of Service
           Face-to-Face Contact and Location Service
           Team Caseload
           Crisis Management
                   Availability
                   Planning and Management
           Family Involvement
           Team Case Coordination
           Comprehensive Mix of Services
           System Collaboration
           Staffing Requirements
           Service Authorization Periods

     Psychosocial Skills Training – Group (Adult)
           Service Definition
           Clinical Exclusions
           Program Requirements
           Place of Service
           Staffing Requirements
           Service Authorization Periods


SERVICE ACCESS AND AUTHORIZATION                              SECTION 31.2
  Service Access and Authorization Process
     Phase One: Screening for MHR Eligibility
     Phase Two: Determining Eligibility and Developing Interim ISRP
           Approval for Eligibility
           Denial for Eligibility
     Phase Three: Requesting Continued Services
           Adult Criteria
           Child/Adolescent Criteria
           Approval for Continued Services
           Denial for Continued Services




                                  Page 3 of 7                 Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:                                       03/01/11
                                 REPLACED:                                      08/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                                               PAGE (S) 7

SUBJECT                                                                   SECTION

    Other Service Access and Authorization Activities
          Request for Revision
          Approval for Revision
          Denial for Revision
    Authorization of Emergency Services
          Emergency Authorization for New Recipients
          Emergency Authorization for Active Recipients
    Recipient Transfer
    Recipient Readmission
    Reconsideration
    Appeal Process
    Provider Closure
    Re-establishing Services to Displaced Recipients Due to Disaster


PROVIDER CERTIFICATION/RECERTIFICATION                              SECTION 31.3
  Initial Certification and Enrollment
    Initial Certification and Enrollment Applications
 Optional Services Certification
    Optional Services Certification Applications
 Certification Process
    Provider Application Review
          Application and Site Review(s)
          Initial Certification Approval and Enrollment
    Loss of Certification
    Discontinuation of Adult PSR and PFII Services
    Recertification
          Failure to Recertify
    Accreditation
    Changes or Events that Must Be Reported
          Changes to Report to Fiscal Agent
          Changes to Report to Medicaid Behavioral Health Section
                Change of Address
                Off-site Service Delivery Location
                Change in Contact Information
                Change of Population
                Change of Ownership (CHOW)
                Request to Discontinue Offering One or More Optional Services


                                  Page 4 of 7                        Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:                       03/01/11
                                 REPLACED:                      04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                                  PAGE (S) 7

SUBJECT                                                       SECTION

                 Agency Closures
                 Staff
                 Accreditation Status
                 Insurance Coverage
                 Hours of Operation
     Reportable Events


PROGRAM OPERATIONS                                       SECTION 31.4
  General Provisions
    Organizational Structure
    Cooperative Agreement
    Policy Manual
    Quality Management Policy
    Program Philosophy
    Provider Operations


STAFFING AND TRAINING                                    SECTION 31.5
  Staffing Requirements
    Personnel Records
          Confidential Information
    Staff Qualifications
          Licensed Mental Health Professional (LMHP)
          Psychiatrist
          Psychologist
          Advanced Practice Registered Nurse (as LMNP)
          Licensed Clinical Social Worker
          Licensed Professional Counselor
          Approved Clinical Evaluator (ACE)
          Mental Health Professional (MHP)
          Mental Health Specialist (MHS)
          Registered Nurse (RN)
          Licensed Practical Nurse (LPN)
    Staff Responsibilities
          Backup Staff
          Supervision
          Initial Supervision
          Ongoing Supervision

                                Page 5 of 7              Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:             03/01/11
                                 REPLACED:            04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                        PAGE (S) 7

SUBJECT                                             SECTION

  Orientation and Training
     Orientation and Training Hours
           Orientation On-Site Instructions
           On-the-Job Training
           LOCUS and CALOCUS Training
           Other Required Training
           Job Specific Training
           Annual Training
           Qualified Trainers
           Bureau Training



RECORD KEEPING                                 SECTION 31.6
  Retention of Records
  Destruction of Records
  Confidentiality and Protection of Records
     Review by State and Federal Agencies
  Administrative and Personnel Records
     Recipient Records
           Components of Recipient Records
           Service Logs


PROGRAM MONITORING                             SECTION 31.7
  Monitoring
     Interviews
     Monitoring Results
     Plan of Correction


ADMINISTRATIVE SANCTIONS                       SECTION 31.8
 Grounds for Sanctioning Providers
       Informal Review
  Notice of Appeal Procedure




                                 Page 6 of 7   Table of Contents
LOUISIANA MEDICAID PROGRAM        ISSUED:                    03/01/11
                                 REPLACED:                   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION: TABLE OF CONTENTS                               PAGE (S) 7

SUBJECT                                                    SECTION

FINANCIAL REIMBURSEMENT                              SECTION 31.9
  General Provisions for Reimbursement
        Information Transfer/Billing Schedule
              Documentation Requirements


ACRONYMS/DEFINITIONS                                 SECTION 31.10

Hardware and IT Requirements                          APPENDIX A

Letter of Attestation                                 APPENDIX B

DHH Research Policy                                   APPENDIX C

Service Log                                           APPENDIX D

Message to EPSDT Eligibles and Parents                APPENDIX E

Service Access and Authorization Documents Defined    APPENDIX F

Contact/Referral Information                          APPENDIX G




                                  Page 7 of 7         Table of Contents
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                08/01/09
                                REPLACED:                                              04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                              PAGE(S) 7



                                        OVERVIEW

The Mental Health Rehabilitation Program is administered by the Department of Health and
Hospitals through a partnership of the Bureau of Health Services Financing (Bureau/BHSF), the
fiscal intermediary, and the network of certified and enrolled providers.

The Bureau is the Louisiana Medicaid Program. The Medicaid Behavioral Health Section
develops program rules, regulations, policies, and procedures for the operation of the program, as
well as manages the operation of the program through prior authorizing services, certifying new
providers, recertifying enrolled providers, monitoring providers, and training activities. It
provides funding for the reimbursement of prior authorized services to certified and enrolled
providers. Contact information:


                      BHSF/Behavioral Health/MHR Program
                      628 North 4th Street
                      Baton Rouge, LA 70802
                      Voice: (225) 342-1203 Fax: (225) 389-8134


Molina Medicaid Solutions is the fiscal intermediary that processes billing claims, assists
providers with billing problems, and completes the enrollment of new providers. Contact
information:


                      Molina Medicaid Solutions Provider Enrollment and Provider Relations
                      Post Office Box 80159
                      Baton Rouge, LA 70898-0159


                      Provider Enrollment Unit:
                      Voice: (225) 216-6370


                      Provider Relations:
                      Voice: (225) 924-5040 or 1-800-473-2783




                                         Page 1 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  08/01/09
                                REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                               PAGE(S) 7

Mental Health Rehabilitation (MHR) services for adults with serious mental illness and children
with emotional/behavioral disorders are outpatient services which are medically necessary to
reduce the disability resulting from mental illness and assist in the recovery and resiliency of the
recipient. These services are home and community-based and are provided on an as needed basis
to assist recipients in coping with the symptoms of their illness. The intent of MHR services is
to minimize the disabling effects on the individual‘s capacity for independent living and to
prevent or limit the periods of inpatient treatment. Providers offer prior authorized services to
adults with mental illness and youth with an emotional/behavioral disorder who meet medical
necessity criteria for services.

This is an optional Medicaid service authorized under Section 440.130 of the 42 Code of Federal
Regulations. All services must be delivered in accordance with federal and state laws, rules and
regulations, this provider manual chapter and any other notices or directives issued by the
Bureau. These services must be delivered by practitioners operating within the scope of their
license as required by the respective Louisiana Practice Acts. It is the responsibility of each
provider to be knowledgeable regarding the policies and procedures governing MHR services
and to be aware of revisions issued by the Bureau.

The provider may only serve recipients who reside in the provider‘s designated service area and
are prior authorized. To obtain a list of designated service areas visit the MHR website,
www.mhrsla.org. Reimbursement will not be paid for a duplicated service or a service provided
without prior authorization. The provider is required to focus on a recipient‘s Individual
Service/Recovery Plan (ISRP) and his/her environment to reduce dependency on services where
the least amount of services is required in the least restrictive environment.

MHR services are expected to achieve the following outcomes:

               Assist recipients in the stabilization of acute symptoms of mental illness;
               Assist recipients in coping with the chronic symptoms of their mental illness;
               Minimize the aspects of mental illness that make it difficult for a recipient to live
               independently;
               Reduce or prevent psychiatric hospitalizations; and
               For children, minimize the amount of time spent in out-of-home placement and
               disruptions in school.




                                          Page 2 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                            08/01/09
                                REPLACED:                                          04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                          PAGE(S) 7

MHR Program Services Package


Covered Services

Listed below are the two categories of MHR services that are currently covered by Louisiana
Medicaid. All providers who participate in the MHR program must offer mandatory services.
Optional services are additional services that may be offered, but require special provider
certification.

Mandatory Services
            Assessment/Reassessment and Service Planning,
            Community Support,
            Individual Intervention,
            Parent/Family Intervention (Counseling),
            Group Counseling,
            Psychosocial Skills Training-Group (Youth), and
            Medication Management.


Optional Services
             Parent/Family Intervention (Intensive), and
             Psychosocial Skills Training-Group (Adult).

The following activities are not MHR services and are not reimbursable:

              Tutoring activities,
              Teaching job related skills (management of symptoms and appropriate work
              habits may be taught),
              Vocational rehabilitation,
              Transportation,
              Staff training ,
              Preparation for group activities,
              Attempts to reach the recipient by telephone to schedule, confirm, or cancel
              appointments,
        Staff supervision ,
        Completion of paper work (including but not limited to service logs, assessments,
              ISRPs) when the recipient and/or their significant others are not present. NOTE:
              Requiring recipients to be present only for documentation purposes is not
              reimbursable.


                                       Page 3 of 7                               Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                   08/01/09
                                REPLACED:                                                 04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                                PAGE(S) 7


               Team meetings and collaboration exclusively with staff employed or contracted
               by the provider where the recipient and/or their significant others are not present,
               Recreational outings,
               Observation of the recipient,
               Staff research on behalf of the recipient, and

NOTE: This list is not all-inclusive.


Screening for Medical Necessity

When a recipient requests services, an initial screening must be completed to determine if the
recipient potentially meets the medical necessity criteria for services. All recipients must meet
the medical necessity criteria for diagnosis, disability, duration and level of care in order to
receive MHR services. If it is determined that the recipient potentially meets the criteria for
services, an initial assessment shall be completed and fully documented in the recipient‘s record
no later than thirty (30) days after the request for services is received.

Recipient data must be entered into MHRSIS. Providers shall also rate recipients on the
LOCUS/CALOCUS and enter the score into MHRSIS at the end of each authorization period
(except the interim authorization), with a request for revision and upon request of the Bureau.
The case record must contain documentation to support the rating including but not limited to,
the initial assessment, reassessment and other supportive documents. The LOCUS/CALOCUS
must be conducted face-to-face by an approved clinical evaluator (ACE).

If it is determined at the initial screening or assessment that a recipient does not meet the medical
necessity criteria for services, the provider shall refer the recipient to his/her primary care
physician, the nearest community mental health clinic, or other appropriate services with copies
of all available medical and social information. Documentation of all referrals must be entered
into MHRSIS.




                                           Page 4 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  08/01/09
                                REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                               PAGE(S) 7



Medical Necessity Criteria

Adult Criteria for Services

In order to qualify for services, Medicaid recipients who are age eighteen (18) or older must
meet all of the following criteria in the areas of diagnosis, disability and duration of disability.

               Diagnosis. The recipient must currently have or, at any time during the past year,
               had a diagnosable mental, behavioral or emotional disorder of sufficient duration
               to meet the diagnostic criteria specified within the Diagnostic and Statistical
               Manual of Mental Disorders (DSM-IV-TR) or the International Classification of
               Diseases, Ninth Revision, Clinical Modification (ICD-9-CM); or subsequent
               revisions of these documents. The diagnostic criteria specified under DSM-IV-
               TR ―V‖ codes, as well as those for substance abuse disorders and developmental
               disorders are excluded unless these disorders co-occur with another diagnosable
               serious mental illness.
                                                  and
               Disability. In order to meet the criteria for disability, the recipient must exhibit
               emotional, cognitive or behavioral functioning, which is impaired, as a result of
               mental illness.     This impairment must substantially interfere with role,
               occupational and social functioning as indicated by a score within levels four (4)
               or five (5) on the Level of Care Utilization System (LOCUS) and can be verified
               by the Bureau.
                                                  and
               Duration. The recipient must have a documented history of severe psychiatric
               disability which is expected to persist for at least a year and requires intensive
               mental health services, as indicated by one of the following:

                       Psychiatric hospitalizations of at least (6) six months duration in the last
                       five (5) years (cumulative total); or
                       Two (2) or more hospitalizations for mental disorders in the last twelve
                       (12)-month period; or
                       Structured psychiatric residential care, other than hospitalization, for a
                       duration of at least six (6) months in the last five (5) years; or
                       A severe psychiatric disability of at least six (6) months duration in the
                       past year.



Acceptable documentation includes, but is not limited to, records from a school, a court, a
psychiatric hospital, a community mental health clinic (CMHC), an outpatient mental health
                                          Page 5 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                   08/01/09
                                REPLACED:                                                 04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                                PAGE(S) 7

center, a physician, the Office of Juvenile Justice Development (OJJ) or the Office of
Community Services (OCS). Documentation must be generated by an authorized professional of
the entity.

NOTE: Recipients who are between the ages of eighteen (18) and twenty ( 21) and who have
been determined not to meet the adult medical necessity criteria for services, initial or continued
care, shall be reassessed by the Bureau or its designee using the children/youth medical necessity
criteria for services.

Children/Youth Criteria for Services

In order to qualify for services, Medicaid recipients who are age seventeen (17) or younger must
meet all of the following criteria:

               Diagnosis. The recipient must currently have or, at any time during the past year,
               had a diagnosable mental, behavioral or emotional disorder of sufficient duration
               to meet the diagnostic criteria specified within the Diagnostic and Statistical
               Manual of Mental Disorders (DSM-IV-TR) or the International Classification of
               Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), or subsequent
               revisions of these documents. The
               diagnostic criteria specified under DSM-IV-TR ―V‖ codes, as well as those for
               substance abuse disorders and developmental disorders are excluded unless these
               disorders co-occur with another diagnosable serious mental illness.
                                                 and
               Disability. In order to meet the criteria for disability, the recipient must exhibit
               emotional, cognitive or behavioral functioning, which is impaired, as a result of
               mental illness.      This impairment must substantially interfere with role,
               educational, and social functioning as indicated by a score within levels four (4)
               or five (5) on the Child and Adolescent Level of Care Utilization System
               (CALOCUS) and can be verified by the Bureau.

NOTE: Youth returning to community living from structured residential settings or group
homes under the authority of the OCS or the OJJ may be considered to meet the disability
criteria with a level of three (3) on the LOCUS or CALOCUS.
                                                      and
                 Duration. The recipient must have a documented history of severe psychiatric
                 disability that is expected to persist for at least six (6) months and requires
                 intensive mental health services, as indicated by at least one (1) of the following:

                   Past psychiatric hospitalization(s);
                   Past supported residential care for emotional/behavioral disorder;
                   Past structured day program treatment for emotional/behavioral disorder; or


                                           Page 6 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  08/01/09
                                REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.0: OVERVIEW                                                               PAGE(S) 7

                   An impairment or pattern of inappropriate behaviors that has persisted for at
                   least three (3) months and is expected to persist for at least six (6) months.

Acceptable documentation includes, but is not limited to, records from a school, court,
psychiatric hospital, CMHC, outpatient mental health center, and OJJ or OCS. Documentation
must be generated by an authorized professional of the entity.


Exclusionary Criteria

Services are not considered to be appropriate for recipients whose diagnosis is mental
retardation, developmental disability or substance abuse unless they have a co-occurring
diagnosis of severe mental illness or emotional/behavioral disorder as specified within DSM-IV-
TR or ICD-9-CM, or subsequent revisions of these documents.


Discharge Criteria

Discharge planning must be initiated and documented for all recipients at the time of their
admission to the program. The written discharge plan must include a plan for the arrangement of
services required to transition the recipient to a lower level of care within the community.
Discharge shall be initiated if at least one (1) of the following situations occurs:

               The goals and objectives on a recipient‘s ISRP have been substantially met;
               The recipient meets criteria for higher level of treatment, care, or services such as
               a Medicare funded day program;
               The recipient meets criteria for higher level of treatment, care or services
               requiring admission to a twenty four (24) hour care facility for thirty (30) days or
               more;
               The recipient, family, guardian, and/or custodian are not engaging in treatment or
               not following program rules and regulation, despite attempts to address barriers to
               treatment;
               Consent for treatment has been withdrawn; or
               Supportive systems that allow the recipient to be maintained in a less restrictive
               treatment environment have been arranged such as a CMHC or other outpatient
               mental health program.
If any one of these situation occur, the provider shall implement the recipient‘s written discharge
plan, which includes a plan for the arrangement of services required to transition the recipient.




                                          Page 7 of 7                                 Section 31.0
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39


                                           SERVICES

Service Delivery
The provider shall provide all mandatory services. Mandatory services shall not be
subcontracted. The provider may choose to provide the optional services, either in house or
through a subcontractor. If the provider chooses to subcontract the optional services, the
subcontractor must meet all provider participation requirements including, but not limited to,
licensing and certification requirements. The provider shall prevent a duplication of services by
ensuring that services requested and offered to a recipient are not available and offered by a non-
MHR provider. Prior to submitting a request for services, the provider shall gather necessary
information from non-MHR providers including, but not limited to, residential programs, case
management services, counseling centers, school based programs, and assertive community
treatment teams to prevent such a duplication. To prevent duplication of services, a copy of the
OCS, OJJ, Office of Addictive Disorders (OAD), Office of Citizens with Developmental
Disorders (OCDD), or any other therapeutic intervention plan must be submitted to the Service
Access and Authorization Unit when requesting services.

There shall be family and/or legal guardian involvement throughout the planning and delivery of
services for children and youths. The agency or individual who has the decision-making
authority for children and youths in state custody must request and approve the provision of
services to the recipient. If applicable, the OCS or OJJ case manager or person legally
authorized to consent to medical care must be involved throughout the planning and delivery of
all services and the provider must document the involvement in the recipient‘s record.

The child or youth must be served within the context of the family and not as an isolated unit.
Services shall be appropriate for the following characteristics:

               Age,
               Developmental level,
               Educational level, and
               Culture.

If a recipient/family is unable or not willing to attend a scheduled appointment, the provider shall
make a reasonable effort to conduct follow-up and outreach services. This may include
scheduling the appointment in the evening or on a weekend, in the recipient‘s home or another
community location. It is a clinical decision when a reasonable effort has been made.
Documentation of all attempts to contact the recipient should be entered in the recipient‘s record.
You may use a service log marked ―For File Only‖.




                                        Page 1 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

When a recipient is discharged, a referral must be made to available community resources and
documented in Mental Health Rehabilitation Services Information System (MHRSIS). If
telephone contact with the recipient or his/her family is not possible, the referral information
must be mailed.


Mandatory Services
Assessment and Service Planning

Service Definition

The initial assessment and reassessment are an integrated series of diagnostic, clinical,
psychosocial evaluations conducted with the recipient and his/her significant others to develop
an effective, comprehensive individualized services and recovery plan (ISRP). It may also be
used to determine the recipient‘s level of need and medical necessity.


Program Requirements

The initial assessment must be completed for all new recipients and for those with a twelve (12)
month or more lapses in service. The initial assessment form must be completed within thirty
(30) calendar days following the initial screening and submitted to the Bureau for approval.
Under exceptional circumstances, at the discretion of the Bureau, extensions beyond the thirty
(30)-day assessment period may be granted on a case-by-case basis. Requests for extensions
should be thoroughly documented and directly related to the reason for the delay. (Example: a
fifteen (15) day extension is being requested because the recipient was hospitalized for fifteen 15
days.)

Information in an initial assessment shall be based on current circumstances (within thirty (30)
days) and face-to-face interviews with the recipient, as well as consider pertinent historical data.
If the recipient is a minor, the information shall be obtained from a parent, legal guardian or
other person legally authorized to consent to medical care.

With the recipient‘s and/or family‘s consent, historical data, including but not limited to past
treatment records, school reports, and/or past assessments, must be requested prior to the start of
the assessment. This data should be reviewed as part of a complete and accurate assessment.
The recipient‘s record must contain documentation of all efforts to obtain this data.

A reassessment must be completed every ninety (90) calendar days after the initial assessment or
as deemed necessary by the Bureau. For example, a reassessment may be required after sixty
(60) calendar days if a provider is requesting a Request for Revision.


                                      Page 2 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39


Information in a reassessment shall be based on circumstances since the most recent
authorization and a face-to-face interview with the recipient. Reassessment data must be
approved by the Bureau. If the recipient is a minor, the information shall be obtained from a
parent, legal guardian or other person legally authorized to consent to medical care. This data is
the foundation of the recipient‘s ISRP.

In order to ensure an adequate and recovery/resiliency focused assessment, providers are
required to utilize a variety of methods to gather assessment data. Assessments must be complete
and accurate given the condition and circumstances of the recipient. To make a clinically valid
assessment, additional methods to gather assessment data should include:

               A review of all prior services that the recipient has received in the past year. This
               may include discharge summaries, service summaries, or copies of clinical
               records.
               Collateral contacts (telephone, face-to- face, and/or written correspondence) with
               prior service providers and other systems (e.g. social services, corrections,
               schools, etc) who are involved with the recipient.
               Interviews with individuals who have directly observed the recipient‘s
               functioning and behaviors in his/her natural environment (home, school, work,
               community).

The information outlined below must be documented in the initial assessment:

               Presenting problem including source of distress, precipitating events, associated
               problems or symptoms and recent progressions,
               Risk assessment, including suicide risk,
               Mental status including at least:
                        Appearance, attitude and behavior,
                        Orientation to person, place, time, and date,
                        Affect and mood, and
                        Thought content/processes including:
                                      Intelligence,
                                      Fund of knowledge,
                                      Cognitive processes,
                                      Memory,
                                      Insight and judgment,
                                      Homicidal/Suicidal risk.
               Personal strengths, abilities and/or interests,
               Previous behavioral health services data (such as a clinical record, discharge
               summary, etc) including:


                                      Page 3 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                       04/01/09
                                REPLACED:                                     06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                   PAGE(S) 39


               Diagnostic information,
               Treatment information (dates, locations, duration, frequency modalities,
               efficacy—including factors that have contributed to or inhibited previous
               recovery efforts), and
               Efficacy of current and previously used medications.
       Physical health history and current status including medication allergies and
       adverse reactions within the last year. There must be evidence of a review by a
       treating psychiatrist as a part of the assessment,
       Medication use profile,
       Developmental history (for recipients under the age of eighteen),
       Pertinent current and historical life situation information that establishes a
       recovery/resilient environment including:
               Age,
               Gender,
               Employment history,
               School/education history including current level of functioning,
               Legal involvement, and
               Family history,
       History of abuse (including trauma survivor issues, spousal/partner abuse,
       physical, psychological, sexual, emotional abuse, and whether the recipient was a
       victim or a perpetrator of said abuse),
       Relationship including natural support,
       Housing or living environment including where, with whom, how long, and how
       stable,
       Use of alcohol, tobacco, and/or other drugs,
               Current level of function in life skills,
       Individualized needs and preferences (e.g., recipient choices of location. service
       type, provider, and focus of services),
       Issues important to the recipient including, but not limited to:
               Cultural background,
               Spiritual beliefs, and
               Sexual orientation,
       Need for and availability of social supports,
       Risk taking behaviors (e.g., unprotected sex, run away, etc.),
       Advance directives if applicable,
       Diagnostic impressions using DSM-IV(or current version), Axes I-V, and
       List of individuals interviewed including location.




                             Page 4 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                              04/01/09
                                REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                          PAGE(S) 39

A comprehensive initial assessment includes the development of a written Integrated Summary
to synthesize, evaluate, integrate, and interpret the data gathered in the assessment. The
Integrated Summary section must include:
              Presenting problem(s) and/or illness(es),
              LOCUS/CALOCUS score,
              The recipient‘s strengths and needs,
              The recipient‘s preferences in services (cultural, location, etc),
              Significant features from any aspect of the assessment including mental status,
              risk factors, medical, medications, etc.,
              Summary of base line functioning,
              DSM IV diagnosis, Axes I-V, and
              Recommended prioritized service objectives and interventions.
The information outlined below must be documented in the reassessment:

              DSM IV diagnosis, Axes I-V;
              The results from the LOCUS/CALOCUS including specific documentation to
              support the overall level of care recommendation and the rating in each
              dimension;
              Medications, including efficacy of current and previously used medications;
              Utilization of crisis services;
              Risk assessment, including risky behavior and suicide risk;
              Current Functional Status including basic needs and mental status exam; and
              Describe:
                   The presence of a co-morbid condition(s),
                   Stressors in the natural environment,
                   Need for and availability of social supports,
                   Resiliency and recovery,
                   Engagement,
                   Treatment barriers,
                   Strengths and needs,
                   Preferences in services (cultural, location, etc), and
                   Barriers to accomplishing goals and objectives.

Reimbursement for initial assessment and reassessment includes all activities but is not limited
to:
            Review of all prior services including discharge summaries, service summaries, or
            copies of clinical records.
            Collateral contacts (telephone, face-to-face, and/or written correspondence) with
            prior service providers, and other systems (e.g., social services, corrections,
            schools, etc).
            Interviews to support direct observations.
                                    Page 5 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

               Face-to-face meeting(s) with the recipient and his/her significant others.
               Administration of the LOCUS/CALOCUS.
               All relevant documentation including service logs and assessment documents.
               Any team or internal meetings required to discuss or review assessment process
               and findings prior to service planning team meeting.

Service Planning

Service Planning is the team process of developing and/or finalizing the recipient‘s
individualized service and recovery plan (ISRP) and Contingency Crisis and Discharge Plans,
periodically reviewing progress toward the goals of the ISRP, and modifying it as indicated. The
ISRP is an individualized, structured, goal-oriented schedule of services developed jointly by the
recipient and treatment team. Recipients must be actively involved in the planning process and
have a major role in determining the direction of their ISRP. The ISRP must identify the goals,
objectives, interventions, and units of service based on the results of an assessment and agreed to
by the adult or youth and his/her parent/guardian. Service planning does not include regular
team meetings, staff training or supervision.

All service requests on the ISRP must be individualized to meet the recipient‘s needs. It is not
permissible to use terms such as ‗as needed‘ or ‗PRN‘ to describe frequency or duration of
services. The ISRP must be developed and reviewed as follows: all timeframes are calendar
days and must be tracked by the date of recipient signature.

An interim ISRP must be developed as part of a recipient‘s initial assessment. Goals and
objectives must address immediate needs identified in the recipient‘s initial assessment,
especially health and safety issues. The initial ISRP must be completed within thirty (30) days
of notice to the provider of the recipient‘s eligibility (refer to section 31.2 Service Access and
Authorization for more detail regarding interim authorizations) and must address the recipient‘s
needs for the first ninety (90) day authorization.

The licensed mental health professional (LMHP) along with the recipient, natural support, and
the treatment team must develop the initial ISRP. ISRP updates are submitted to the Bureau
every ninety (90) days as part of the reassessment, with a request for revision, or as requested by
the Bureau. The community support worker may draft updates to the ISRP with the recipient
and natural support. The LMHP must review and sign the final ISRP as part of the service
planning team meeting as outlined below.

The ISRP must be updated to reflect changes made to services. Changes may include developing
and revising goals, objectives, interventions, the discharge plan, and the crisis plan. The
recipient and/or family members must sign or initial each change. Though the ISRP does not
need to be resubmitted each time a change is made, a summary of the changes must be described
when requesting a reauthorization.
The ISRP must:
                                      Page 6 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                04/01/09
                                REPLACED:                                              06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                            PAGE(S) 39


               Be based on the needs and desires of the recipient and focused on his/her
               integration and inclusion into the local community, the family, and, when
               appropriate, natural support systems.
               Involve the family of the recipient when applicable and permitted.
               Identify any needs beyond the scope of the MHR program.
               Specify the services that will be provided.
               Specify referrals to any services provided by other providers or community
               resources.
               Be provided to the recipient/family in writing.

The ISRP must be written using language that the recipient will understand. Complex words and
phrases, medical terms, and abbreviations must not be used in an ISRP. The ISRP must be
appropriate to the recipient‘s culture and age (chronological and developmental). Updated
ISRPs must include an explanation of progress made toward meeting goals and objectives (i.e.
met, not met, and discontinued). Failure to meet a goal or objective indicates the need for an
ISRP revision.

The ISRP must include a list of prioritized needs identified in the most recent assessment as well
as a list of services beyond the scope of what the agency can provide (for example, access to
substance abuse treatment, physical health treatment, sexual abuse treatment, vocational
rehabilitation, recreational activities, and inpatient care). The provider is responsible for
coordinating all services.

The ISRP must include the following components:

               Goals
               Objectives with target dates
               Interventions
               Individualized/Recovery Focused Crisis Plan
               Discharge Plan

Goals
        A goal is defined as a broad statement that reflects what a recipient hopes to accomplish
        to address a priority need. They are more general than objectives and should be targeted
        for completion within the authorization period. Each goal must include:
                   A description of the recipient‘s strengths, resources, and supports,
                   Specific objective(s) with target dates, and
                   Specific intervention(s).




                                     Page 7 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

Objectives
      Objectives are defined as the smaller more specific steps necessary to accomplish a goal
      and reflect the recipient‘s and treatment team‘s expectations. They must take into
      account the recipient‘s age, development, disabilities and concerns. Objectives must be
      developed following the principles of S-M-A-R-T, which requires objectives to be:

                  Specific,
                  Measurable,
                  Action-oriented,
                  Realistic, and
                  Time limited.

       Objectives that are not developed in accordance with the principles of S-M-A-R-T may
       result in a denied authorization request and/or sanctions following a post payment review.

       Specific objectives make it clear to the recipient, family, and staff exactly what is to be
       done. Specific objectives allow the recipient, family and staff to determine if changes are
       needed to the service plan including, but not limited to, frequency of contact, service
       type, and effectiveness of a behavioral intervention plan. Objectives must be based on
       observable behaviors/skills the recipient will target for development or improvement
       during the authorization period. Objectives which include phrases such as ―improve
       school behavior‖ or ―will learn more independent living skills‖ are considered to be too
       general.

       Measurable objectives allow recipients, natural supports, and staff to determine whether
       an objective is being accomplished. In order to establish measurable objectives, staff
       must gather baseline data as well as collect ongoing data while services are being
       provided. Data collection determines the extent to which a recipient needs to improve
       his/her behavior or skills as well as to determine the type of measure that will be used to
       verify that an objective has been achieved.

       Data collection may include the use of standardized assessment tools, checklists, and
       observations. Measures may include improved grades (from a C to an A), an increase in
       the frequency of a positive behavior or skill, or the dollar amount a recipient may deposit
       in his/her savings account.

       Action oriented objectives make it clear to the recipient, family, and staff what the
       recipient is expected to do, instead of what the recipient is to stop doing. Action oriented
       objectives are positive in nature, and give the recipient a road map for dealing with
       problems or issues related to his/her mental illness. Objectives that are negative such as
       ―I will stop fighting‖ or ―I will reduce my symptoms‖ do not promote positive changes
       and learning.


                                     Page 8 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

       Objectives should be based on a recipient‘s strengths, needs, interests, and abilities.
       Developing realistic objectives involves building on strengths while developing new
       skills, abilities, interests, and personal insight. The team members must work closely
       with recipients and family to establish objectives that are reflective of the recipient‘s
       abilities.

       Objectives must include realistic target dates that do not exceed the authorization period.
       For planning purposes, target dates are used to identify for the recipient, family, and staff
       the amount of time that the team expects it will take to accomplish each objective. If an
       objective is not accomplished by the established target dates, the team may adjust the
       time-period or modify the objective.

Interventions
       Interventions are methods that the provider uses to help a recipient achieve his/her
       objectives. LMHP staff is responsible for ensuring that staff members are competent to
       provide the interventions detailed in the ISRP. Interventions should be well defined for
       all team members, and relate to an objective. Interventions that include teaching skills
       should be very specific and should include the teaching methods (modeling, role-play,
       etc.). Interventions must be active in nature, and do not include ―watchful oversight.‖
       The recipient, family, natural support, and staff should be clear as to how the objective
       will be addressed.

       Therapeutic interventions such as cognitive-behavioral therapy (CBT) and behavior
       modification should be documented in the intervention. Evidence based strategies should
       be used, if appropriate.     Interventions that are general such as ―assist‖, ―develop‖,
       ―teach‖ without specific details may result in a denied authorization request and/or
       sanctions following a post payment review.

       NOTE: For a list of evidenced based strategies, visit the Substance Abuse and Mental
       Health Services Administration (SAMHSA) website at www.samhsa.gov or visit the
       MHR website, www.mhrsla.org, for a link to resources.

Individualized/Recovery Focused Crisis Plan
       The crisis plan must be developed as part of the initial assessment and updated with the
       ISRP. The recipient, family, and staff develop and update the crisis plan based on an
       ongoing assessment of the recipient‘s risk, skills, and natural support. The recipient must
       have a copy of the current plan. The plan should be posted in a common area of the
       home near a telephone. MHR staff must ensure that the recipient and his/her natural
       support understand all aspects of the plan. This may include skills training with the
       recipient as well as natural supports who will be involved in the implementation of the
       plan.




                                      Page 9 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

       Providers must not list 911 as the first and only contact telephone number. Instead, the
       provider must educate the recipient regarding circumstances that will necessitate calling
       911 for emergency assistance. Current contact telephone numbers must be maintained on
       the crisis plan. Evidenced based methods such as the Wellness Recovery Action Plan
       (WRAP) should be used if appropriate.

       When an agency agrees to provide services to a recipient at Level five (5), it is done with
       the understanding that it is imperative that the agency develop a safety/crisis plan that
       will provide for the safety of the recipient twenty four (24) hours a day. Those agencies
       who do not have the expertise or resources available to meet this requirement should not
       agree to provide services to recipients who score a Level five (5) on the
       LOCUS/CALOCUS. Services for Level five (5) recipients must include comprehensive
       clinical services, support services, crisis stabilization services, and prevention services.

The crisis plan must:
       Describe what constitutes a crisis for the recipient. The team may consider events that
       caused the need for hospitalization in the past and caused significant distress for this
       recipient. Staff should ask the recipient to describe events he/she would consider a crisis.

       Describe events/situations that may be precipitants to a crisis. The team may describe
       behaviors/situations that have happened just before (triggered) crisis in the past and list
       observable behaviors which, for this recipient, mean that things have worsened and may
       be close to becoming a crisis (warning signs).

       Describe what action (s) can be taken by the recipient and/or natural supports to address
       the crisis which may include specific behavior strategies and environmental safeguards.
       If there are currently no natural supports available, the team should consider including
       goal (s) on the ISRP to focus on developing natural supports.

       Describe what action (s) can be taken by staff based on the needs of the recipient to
       ensure primary health and safety needs are met. Staff responding to a crisis must have a
       copy of the current plan and must receive training regarding the intervention methods
       detailed in the plan.

       Include the name, address, telephone number of supporters the recipient wishes to help
       them when at risk of entering or in a crisis. It is important that the list of supporters is
       current with accurate information including name/contact number/assigned task of each
       supporter.




                                      Page 10 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                             04/01/09
                                REPLACED:                                           06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                          PAGE(S) 39

       Include the name, title, and contact information for the primary community support
       worker and other agency support staff including the LMHP and the psychiatric director.
       Staff shall ensure that agency contact information is clear, accurate, and up-to-date.

       Include other instructions from the recipient as well as information that he/she would
       want others to know/follow in times of crisis. The plan should include pertinent
       information from the recipient‘s advance directive.

Discharge Plans
      Discharge planning is the formal process that leads to the development of an ongoing
      individualized plan of care that meets the assessed needs of the recipient upon discharge
      from service. The first discharge plan is developed during the interim authorization. The
      plan is updated as needed. The updated plan is submitted with each quarterly
      authorization request or at the request of the Bureau. MHR staff, particularly the
      community support worker, is responsible for coordinating and implementing the plan.
      Any specific recipient circumstances (e.g., housing, job, school) that must be in place
      prior to discharge or transition. The plan should address the following areas:

              Physical health
              Safety/Emergency
              Use of medication
              Home management (cleaning, cooking, maintenance)
              Budgeting
              Transportation and travel
              Recreation and leisure
              Social and personal skills

A written draft of the proposed ISRP may be developed outside of the service planning team
meeting with final changes made during the meeting. Effective service planning must include
representation from all systems of support and care in which the recipient is engaged. The
service planning team at a minimum must be comprised of the:

              Recipient,
              Recipient‘s primary LMHP,
              Recipient‘s primary community support worker,
              Recipient‘s family or caretaker(s), if the recipient is a youth, and
              OJJ or OCS caseworker, if the recipient is in their custody. If the OJJ or OCS
              caseworker is not physically present at the service planning team meeting, a good
              faith effort shall be made to schedule a teleconference or videoconference during
              the service planning team meeting or to arrange the meeting at the OCS or OJJ
              office.


                                    Page 11 of 39                                 Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                04/01/09
                                REPLACED:                                              06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                            PAGE(S) 39

It is desirable for the following additional team members to participate in service planning as
applicable:
               All staff providing direct services to the recipient and his/her family,
               Prescribing psychiatrist if other than the MHR contracted or employed
               psychiatrist, and
               Representatives from other systems of care or services in which the recipient is
               engaged including but not limited to:
                       Schools,
                       Juvenile/adult corrections or justice related,
                       Acute care facilities,
                       Child welfare/social services,
                       Other service/community providers.

The provider must have an original completed, dated sign-in team meeting document, as well, as
evidence of invitations extended to the meeting such as copies of letters, emails or service logs.
Each ISRP must be reviewed, signed and dated by the:

               Recipient,
               Recipient‘s primary LMHP,
               Recipient‘s primary community support worker,
               Recipient‘s family or care taker(s), if the recipient is a youth

OJJ or OCS representative if the recipient is in their custody, and the psychiatrist. In the event
the psychiatrist is not present at the meeting during review of the ISRP, the MHR or Non-MHR
psychiatrist must review the ISRP within ten (10) calendar days following the meeting and sign a
certification statement. If the recipient has selected a non-MHR psychiatrist, the MHR
psychiatrist must complete a service log to document consultation with the non-MHR
psychiatrist prior to submitting the initial ISRP and at least quarterly thereafter. Documentation
of all required invitation and participation of service planning stakeholders as delineated above
must be maintained.


Staffing Requirements

The psychiatrist shall:
               Conduct a face-to-face interview with the recipient at initial assessment.
               Review and sign the Medical History Questionnaire section of the initial
               assessment during a face-to-face contact.
               Review, sign and date the ISRP at initial assessment and reassessment.
               Review and sign the Electronic Clinical Data Inquiry (e-CDI) screen print. If no
               data is available, the screen print must also be signed.

                                      Page 12 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

NOTE: The provider must ensure and document that a recipient who chooses a non-MHR
physician who is not a psychiatrist receives a face-to-face interview, review of Medical History
Questionnaire section, review of the ISRP and review of the e-CDI screen performed by a
qualified psychiatrist.
The licensed mental health professional (LMHP) shall:

               Direct the gathering of the assessment data.
               Conduct a face-to-face interview with the recipient. The recipient‘s
               family/significant other(s) should also be interviewed when possible if approved
               by the recipient. For a recipient who is a minor, an interview with the custodial
               parent(s) is mandatory.
               Score LOCUS/CALOCUS if he/she has been designated by Medicaid Behavioral
               Health Section as an Approved Clinical Evaluator (ACE).
               Develop the Integrated Summary as part of the initial assessment.
               Conduct a mental status exam as part of the initial assessment and reassessment.
               LMHP staff must have documented experience with conducting mental status
               exams.
               Determine the presence of a DSM IV diagnosis, Axes I-V as part of the initial
               assessment and reassessment. The LMHP must have documented experience
               with determining psychiatric diagnosis.
               Develop, sign and date the initial assessment and the reassessment forms.
               Obtain information about the recipient that may minimize the need for use of
               restraint or seclusion.
NOTE: An advanced practice registered nurse (APRN), clinical nurse specialist (CNS) or a
nurse practitioner (NP) may not sign the initial assessment without the signature of the treating
psychiatrist.
The initial assessment and reassessment shall be billed by the LMHP coordinating the
assessment activities. Although they may not bill for the service, other qualified staff such as a
mental health professional (MHP) or a mental health specialist (MHS) may participate in
gathering data. The LMHP must complete a service log on the date the assessment is completed
and enter into MHRSIS to be reimbursed.

NOTE: Staff must not bill community support while gathering and reporting reassessment
information.

Service Specific Documentation Requirements

Service logs must be completed for all contacts during an assessment and filed in the recipient's
record, though not all logs are entered into MHRSIS. Providers shall follow current MHRSIS
policies regarding entering data.


                                      Page 13 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

Service Authorization Periods

               Thirty (30) days for initial assessment
               Up to ninety (90) days for the reassessment



Community Support

Service Definition

Community support is the foundation of the recovery-oriented ISRP and is essential to all
recipients. Its goal is to increase and maintain competence in normal life activities and gain the
skills necessary to allow them to remain in or return to their own natural environment. It
provides the necessary services to assist the recipient in achieving and maintaining rehabilitative,
resiliency and recovery goals related to education, work, housing, mental health treatment,
financial and social supports and other support needs Community support includes crisis
intervention, coordination of MHR and non-MHR services, and individual skills training.

Specific goals of the service are:

             To achieve the restoration, reinforcement, and enhancement of skills and/or
             knowledge necessary for the recipient to achieve maximum reduction of his/her
             psychiatric symptoms.
             To minimize the effect of mental illness.
             To maximize the recipient's strengths with regard to the mental illness.
             To increase the level of the recipient's age-appropriate behavior.
             To increase the recipient‘s independent functioning to an appropriate level.
             To enhance social skills.
             To increase adaptive behaviors in family, peer relations, school and community
             settings.
             To maximize the skills to link and engage with other community services including
             natural supports and resources.
             To apply decision-making methods in a variety of skill building applications.




                                      Page 14 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                    04/01/09
                                REPLACED:                                                  06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                               PAGE(S) 39

Program Requirements

Community support is an individualized service and is not billable if delivered in a group setting.
Each recipient shall have one designated provider who will serve as the ―mental healthcare
home‖ for the recipient and family. The recipient will choose a designated community support
worker who is the primary point of contact. While the community support worker provides the
majority of community support activities, he/she may not be the exclusive provider.

The community support worker acts as the first responder (triage, support and intervention) for
recipients in crisis, which may include face-to-face contact. When he/she is unavailable, there
must be a backup worker. The name of the backup worker and how to contact him/her must be
provided in writing to the recipient and the family (if the recipient is a minor) or caregiver. If the
emergency is of a clinical nature, the MHP/MHS must consult with the LMHP or psychiatric
director if the recipient‘s circumstances are beyond his/her ability to ensure the safety of the
recipient and others.

The community support worker assures access to and coordination of MHR and non- MHR
services, subject to the face-to-face and community ratios, through the following activities:

               Establishing/maintaining interagency coordination, which may include education,
               Louisiana Rehabilitation Services (LRS), OAD, OCDD, OCS and OJJ.
               Example: A youth who is at risk of entering the juvenile justice system may need
               coordination with the Family In Need of Supervision (FINS) program.
               Engaging in collateral consultation with other service systems or individuals
               (family members, significant others and professionals) who are actively involved
               in the recipient‘s care, ensuring a comprehensive set of services and preventing
               duplication.
               Promoting active recipient involvement by:
                       Contacting the recipient face-to-face and by telephone.
                       Providing aggressive outreach if recipient participates less than specified
                       in the ISRP. Aggressive outreach includes making every reasonable effort
                       to provide continuing care, which may include enlisting the help of natural
                       supports. Aggressive outreach should continue until the recipient resumes
                       services or is successfully referred to another service provider.
               Monitoring the recipient‘s self-management of symptoms.
               Drafting updates to the ISRP with the recipient and natural supports. The LMHP
               must review and sign the final ISRP as part of the service planning team meeting
               as outlined below.




                                       Page 15 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                             04/01/09
                                REPLACED:                                           06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                         PAGE(S) 39

NOTE: Services that meet the service definition of Medication Management are excluded.

The community support worker provides individual skills training, which must be based on a
curriculum or other published material that represents nationally recognized best practices.
Targeted areas of skills training typically include:

          Socialization skills.
             Communication,
             Interpersonal relationships, including those with peers, family, and authority
             figures,
             Problem solving/conflict resolution,
             Management of sensory input and stress.
          Natural support system development that includes self-directed engagement in
          community social activities and the development of a social plan.
          Adaptation skills.
             Identification of behaviors that interfere with performance,
             Implementation of interventions to alleviate problem behavior, including coping
             with symptoms of mental illness that affect the person's ability to successfully
             work and/or attend school,
             Development of the ability to follow directions and carry out assignments,
             Acquisition of appropriate school habits,
             Adaptation to community, environmental and/or family circumstances and
             realities,
             Education in mental health/mental illness,
             Development of individual day-to-day skills necessary for the recipient to comply
             with taking prescribed medications (services that meet the definition of
             medication management should be provided by staff credentialed to offer that
             service),
             Development of day-to-day skills necessary for the recipient to identify, monitor,
             and self-manage his/her psychiatric symptoms, which interfere with their daily
             living, financial management, personal development, school or work
             performance.
          Developmental issues.
             Physical changes,
             Emotional changes, and
             Sexuality.
          Daily living skills.
             Age and developmentally appropriate daily and community living skills,
             Personal hygiene and grooming,
             Nutritional services,
          Food planning, grocery shopping, cooking, and eating,


                                   Page 16 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               04/01/09
                                REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                           PAGE(S) 39

               Household maintenance, including housecleaning and laundry,
               Money management and budgeting, and
               Shopping for daily-living necessities.
           Community awareness and current events.
           Identification and use of social and recreational skills.
           Use of available transportation.
           Personal responsibility,
           Work readiness activities (excepting skills related to a specific vocation, trade, or
           practice) including:
                       Work related social and communication skills;
                       Work related personal hygiene and dress;
                       Work related time management; and
                       Other related skills preparing the recipient to be employable.


Place of Service and Frequency of Contact

Community support is primarily a face-to-face service and is primarily provided in the home or
other community setting. Sixty (60) percent of the contacts provided during an authorization
period must be face to face. No less than eighty (80) percent of those face-to-face contacts must
be provided in the home or community. Contacts occur during times and locations best suiting
the recipient‘s needs including after school, after work, evenings and weekend hours and include
the following settings:

              Recipient‘s home;
              School;
              Other community environment which allows for privacy and confidentiality and is
              appropriate to the age, level of need, and structure needed for the recipients; or
              The MHR facility.


Staffing Requirements

Community Support may be provided by an:
        LMHP
        MHP or MHS under the supervision of an LMHP

Caseloads shall be effectively managed based on the recipient‘s needs and shall not exceed 1:30
(one (1) community support worker for each thirty (30) recipients receiving community support
services).



                                     Page 17 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

Service Authorization Periods

               Interim – thirty (30) days
               Initial – ninety (90) days
               Subsequent – ninety (90) days



Group Counseling

Service Definition

Group counseling is a face-to-face interaction between two to eight recipients. It is a therapeutic
service utilizing specific interventions, which must be documented in the recipient‘s ISRP.
Evidenced based strategies should be used when applicable. Sessions are typically limited to one
(1) hour.

Clinical Exclusions

The provider shall not admit any recipient who poses a documented health and safety risk to
himself/herself, to other recipients, or for whom the provider cannot provide the necessary care.

Program Requirements

The service is directed to the goals on the approved ISRP. Sessions are scheduled to provide
effective treatment consistent with the ISRPs of the group members. It should be available at
times most convenient to the recipient/family needs and requests, including evenings and
weekends. Participants must be of similar age, developmental level and psychosocial need. For
children, if age difference exceeds three (3) years, the provider must document the basis for
inclusion in the group in the recipient‘s record (service log or progress note).

Group counseling will be limited to the following topical areas:

              Anger management.
              Behavior management.
              Grief/loss.
              Trauma (sexual/physical/verbal).
              Sexual offenders.
              General symptom management skills, including:
                   Identification and management of symptoms of mental illness;
                   Compliance with physician‘s medication orders; and
           Reduction and alternatives to aggression.
                                      Page 18 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

Topics and interventions (including those conducted in multi-family groups) must be consistent
with the above topics and be directed exclusively to goals/objectives on the recipient‘s ISRP.
Parenting skills training related to these topics may also be included.

NOTE: Collateral contacts or other non-face-to-face contacts are not billable under this service
code.

Place of Service

This service may be provided at an MHR facility or off-site service delivery location as defined
in Section 31.4. However, it shall not be provided at a site that serves as a group living
environment, such as a board and care facility, group home or apartment building that serves as a
residence for more than one MHR recipient.

Staffing Requirements

Group size may not exceed one (1) staff member to eight (8) group participants. A staff member
must be present at all times during the group session. If a group is co-facilitated by more than
one (1) staff member, only one (1) staff member can bill for each recipient.

The following individuals may provide Group Counseling:
              An LMHP
              An MHP under the supervision of an LMHP

Service Authorization Periods and Service Limits

           Interim – None
           Initial – ninety (90) days
           Reassessment – up to ninety (90) days



Individual Intervention


Service Definition

Individual intervention is an interaction between the counselor/therapist and the recipient. It is a
face-to-face structured service based on a range of professional therapeutic strategies, which
must be documented in the recipient‘s ISRP. Evidenced based strategies should be used when
applicable. Sessions are typically limited to one hour. For contacts lasting longer than one hour,
the service log must include the reason for the extended session.
                                      Page 19 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                04/01/09
                                REPLACED:                                              06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                            PAGE(S) 39




This service is provided to ameliorate the psychosocial barriers that impede the development or
enhancement of skills necessary to function in the community.

Individual Intervention is relevant to the recipient‘s needs and relate directly to the
individualized goals and objectives specified in the ISRP.

These services are based on psychological treatment principles. Specifically, these include
counseling and therapy services that:

               Maximize strengths;
               Reduce behavioral problems;
               Change behavior;
               Improve interpersonal skills;
               Explore and clarify values; and
               Facilitate interpersonal growth and change.


Place of Service

This service may be provided in the recipient‘s home, an MHR facility, school, or other off-site
service delivery location. It should be available at times most convenient to the recipient
including evenings and weekends.

NOTE: Collateral contacts or telephone contacts are not billable under this service code.


Staffing Requirements

The following individuals may provide Individual Intervention:

               An LMHP
               An MHP under the supervision of an LMHP


Service Authorization Periods

               Interim – None
               Initial – ninety (90) days
               Reassessment – up to ninety (90) days

                                     Page 20 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

Medication Management


Service Definition

Medication management is provided to:

               Assess,
               Monitor a recipient‘s status in relation to treatment with medication,
               Instruct the recipient, family, significant others or caregivers of the expected
               effects of therapeutic doses of medications, or
               Administer prescribed medication when ordered by the psychiatrist (or other
               prescriber as allowed under applicable law) as part of an ISRP that is inclusive of
               additional rehabilitation services and supports.


Program Requirements

All activities of medication management must be provided face-to-face and at a minimum shall
be available to recipients during normal operating hours. It cannot be provided in a group
setting. Necessary collateral or telephone contacts are included in the reimbursement for this
service and must not be billed.

This service includes four primary activities:

       Initial Medication Assessment—the initial assessment of the need for, type and dosage of
       medications directed toward maximizing a recipient‘s functioning and reducing
       symptoms. This assessment is minimally inclusive of:

               Medical history-general health.
               Review of past medication history.
               Other prescriptions including non-psychotropics.
               Untoward side effects and contraindications.
               History of compliance.
               Efficacy of past/current medication prescribed to treat a behavioral disorder.
               Review of abuse history (prescription/non-prescribed).
               Medication type and dosage ordered as a result of the assessment.

           Medication administration—the administration of therapeutic doses of medication for
           the treatment of mental disorders that have been prescribed and are monitored by a
           psychiatrist (or other prescriber as allowed under applicable state law) and indicated
           in the recipient‘s ISRP.

                                      Page 21 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               04/01/09
                                REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                           PAGE(S) 39



       ―Administration‖ shall be interpreted consistent with applicable state law but minimally
       is inclusive of injectables (shots), direct dosing of oral medications, and repackaging of
       oral medication into ―pill boxes‖ or daily dosage boxes when pills are placed in the boxes
       directly by staff credentialed to administer medications.

       Medication monitoring—the ongoing review of symptoms, side effects, effectiveness,
       applicable lab or other measures, compliance, and prescription renewal and adjustment of
       psychotropic medications.

       Medication education—involves the instruction of the recipient, family, significant
       others, and care givers on the expected effects of prescribed medication.

Medication Education may include but is not limited to:

              Proper use and storage of medications.
              Rationale for the medication.
              Possible side effects, including impact on pregnancy, age, sex, or disability.
              Early warning signs of relapse and signs of non-adherence and noncompliance
              with medication prescription.
              Circumstance/symptoms requiring contact with a medical professional.
              Use/interactions with other substances (prescribed/non-prescribed).
              Instruction on the proper self-administration of medications.

If an individual is in crisis and the prescribing practitioner changes the medication or dosage,
medication education must be provided within one (1) business day.

The following frequency of service requirements apply to all recipients on psychotropic
medications for which the provider is the primary prescribing and monitoring entity:

              Initial medication assessment – completed and documented in the clinical record
              during the interim authorization period, not to exceed thirty (30) days from the
              date eligibility was determined.

              Monitoring – provided as justified by recipient need but in no case less frequently
              than once every ninety (90)-calendar days.

              Medication administration – frequency as required by prescription, orders and the
              ISRP.



                                     Page 22 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

               Medication education – as required in the ISRP, but minimally must be
               documented in the clinical record at the time of any change in medication
               including dosage or type.

The administration of all medications, medication errors, and adverse drug reactions must be
documented. Within thirty (30) days of the initial assessment and ninety (90) days thereafter, a
physician must conduct an evaluation. There must be a process for immediately notifying the
attending physician of drug reactions, medication errors, and /or other related problems.


Storage of Medications

Only staff authorized to administer or supervise self-administration of medication shall have
access to medications. All medications must be handled in accordance with applicable state and
federal law including:

           Labeling all medications properly and storing them under lock and key.
           Storing medications for external use separately from internal and injectable
           medications.
           Storing disinfectants separately from all medications.
           Storing medications under proper conditions of sanitation, temperature, light,
           moisture and ventilation.
           Removing outdated medications and disposing of them.
           Disposing of needles in accordance with the established Occupational Safety and
           Health Administration (OSHA) policy for handling medical waste.

The telephone number of existing poison control centers, ambulance and other emergency
medical centers should be readily accessible to the staff and recipient.


Staffing Requirements

Medication Management is limited to licensed medical practitioners operating within their scope
of practice as allowed under the applicable state law(s). In addition, psychiatrists (M.D. or D.O.)
shall be board eligible (as defined by the Bureau) or board certified. Advanced Practice
Registered Nurse (APRN)/Clinical Nurse Specialist (CNS) or a Nurse Practitioner (NP) must
operate under an approved collaborative practice agreement with a board certified or board
eligible psychiatrist. The Louisiana State Board of Nursing must approve the collaborative
practice agreement prior to delivering services.

Credentials allowable for core activities within medication management are as follows:



                                      Page 23 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                            04/01/09
                                REPLACED:                                          06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                        PAGE(S) 39




              Initial Medication Assessment
                      Psychiatrist
                      APRN/CNS or NP certified in psychiatry
              Medication Administration
                      Psychiatrist
                      APRN/CNS or NP certified in psychiatry
                      Registered Nurse (RN)
                      Licensed Practical Nurse (LPN)
              Medication Monitoring
                      Psychiatrist
                      APRN/CNS or NP certified in psychiatry
                      Registered Nurse (RN)
              Medication Education
                      Psychiatrist
                      APRN/CNS or NP certified in psychiatry
                      Registered Nurse (RN)


Service Specific Documentation Requirements

In addition to documentation required for each contact, the following specific documentation
must be present in recipients‘ records for whom Medication Management is provided:

          Medication Administration Record (MAR)
          Medication Errors and Reporting Form
          Adverse Event Drug Reporting Form (pharmacy or drug related)
          e-CDI printout
          Medication Consent
          Physician‘s Orders
          Lab results (as applicable)
          Medication education documentation (for each prescribed drug when initially
          prescribed)


Place of Service

This service may be provided at the MHR office, an off-site service delivery location or in a
recipient‘s natural environment (schools, home, etc) appropriate to the recipient‘s needs and
circumstances and in compliance with privacy and confidentiality requirements.
                                   Page 24 of 39                                Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39



Service Authorization Periods

           Interim – thirty (30) days
           Initial – ninety (90) days
           Reassessment – up to ninety (90) days



Parent/Family Intervention (Counseling)


Service Definition

Parent/Family Intervention (Counseling) is a face-to-face therapeutic intervention involving the
recipient and one or more family members. The primary goal is to help the recipient and family
improve their overall functioning in the home, school, work and community settings. This goal
is accomplished by helping the recipient and family increase effective coping mechanisms,
healthy communication strategies, constructive problem-solving skills and increased insight into
the nature of the recipient‘s difficulties and the impact on the family. This service utilizes
specific interventions, which must be documented in the recipient‘s ISRP. Evidenced based
strategies should be used when applicable and tailored to address the recipient‘s and family‘s
needs. These services are intended to be time limited with services reduced and discontinued as
the family functions more effectively.

Parent/Family Intervention includes regularly scheduled face-to-face interventions, with the
recipient and family designed to improve family functions. Specific interventions may include:

           Assisting the family with developing and maintaining appropriate structure within the
           home.

           Assisting the family with developing increased understanding of the recipient‘s
           symptoms and problematic behaviors and developing effective strategies to address
           these issues, and encouraging emphasis on building upon the recipient and family‘s
           strengths.

           Facilitating the family‘s ability to effectively manage, teach, and positively reinforce
           the recipient‘s strengths.

           Facilitating effective communication and problem solving between the recipient and
           family members.

                                     Page 25 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               04/01/09
                                REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                           PAGE(S) 39

Program Requirements
The service should be available at times of operation most convenient to the recipient/family
needs and requests, including evenings and weekends.
The recipient must be present for counseling sessions except where therapeutically
contraindicated. Reasons must be documented in service logs for each meeting in which the
recipient is not present. Necessary collateral or telephone contacts are included in the
reimbursement for this service and are not billable.

Place of Service

Services may be provided at the MHR office, an off-site service delivery location, or in a
recipient‘s natural environment (school, home, etc.) as appropriate to recipient needs and
circumstances and in compliance with privacy and confidential requirements.

Staffing Requirements
The following individuals may provide Parent/Family Intervention (Counseling):
          An LMHP
          An MHP under the supervision of an LMHP

Service Authorization Periods

           Interim – None
           Initial – ninety (90) days
           Reassessment – up to ninety (90) days


Psychosocial Skills Training – Group (Youth)

Service Definition

Psychosocial Skills Training – Group (Youth) is a face-to-face therapeutic, rehabilitative, skill
building service for children/youth to increase and maintain competence in normal life activities
and gain the skills necessary to allow them to remain in or return to their communities. It is an
organized service based on models incorporating psychosocial interventions. The goals of the
service include:

           To achieve the restoration, reinforcement, and enhancement of skills and/or
           knowledge necessary for the recipient to achieve maximum reduction of his/her
           psychiatric symptoms.



                                     Page 26 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                   04/01/09
                                REPLACED:                                                 06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

           To minimize the effect of mental illness.

           To maximize the recipient's strengths.

           To increase the level of the recipient's age-appropriate behavior.

           To increase the recipient's independent functioning to an appropriate level.

           To enhance pro-social skills.

           To increase adaptive behaviors with family and peers and in school and community
           settings.


Clinical Exclusions

The provider shall not admit any recipient who poses a documented health and safety risk to
himself/herself, to other recipients or for whom the provider cannot provide the necessary care.


Program Requirements

Psychosocial Skills Training has a structured curriculum that is adapted to the recipient‘s needs
and teaches skills necessary to succeed in his/her environment. The curriculum must be
nationally recognized best practice standards and be age and developmentally appropriate and
culturally relevant.

Participants must be of similar age, developmental level and psychosocial need. If age
difference exceeds (3) three years, the basis for inclusion in the group must be documented.

Training material must include activities that will allow the recipient to practice the skill(s)
taught during the group session and natural settings. This will allow the recipient to further
develop and integrate the skill.

If a recipient completes a curriculum but needs additional training, Community Support should
be used during or after the group sessions as a more individualized method of training.

The curriculum is designed to improve or maintain the recipient's ability to function in normal
social roles and should include but not be limited to:




                                     Page 27 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               04/01/09
                                REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                           PAGE(S) 39

Socialization skills
                       Communication,
                       Interpersonal relationships, including those with peers, family, and
                       authority figures,
                       Problem solving/conflict resolution,
                       Management of sensory input and stress,
                       Natural support system development,
                       Self-directed engagement in community social activities (development of
                       a social-recreational plan for the recipient), and
                       Decision-making.

Adaptation skills
                       Identification of behaviors that interfere with performance,
                       Development of interventions to alleviate problem behavior, including
                       coping with symptoms of mental illness that affect the person's ability to
                       successfully work and/or attend school,
                       Development of capacity to follow directions and carry out assignments,
                       Acquisition of appropriate school habits, and
                       Adaptation to community, environmental and/or family circumstances and
                       realities.

Education in mental health/mental illness
                     Management of symptoms of mental illness to minimize the negative
                     effects of psychiatric symptoms, which interfere with the recipient's daily
                     living, personal development, and community integration (services that
                     meet the definition of medication management should be provided by staff
                     credentialed to offer that service).
                     Developing skills necessary for the recipient to comply with prescribed
                     medications.
                     Developmental issues including:
                             Physical changes,
                             Emotional changes, and
                             Sexuality.




                                     Page 28 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                    04/01/09
                                REPLACED:                                                  06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                                PAGE(S) 39

Daily living skills for children/youth transitioning to independent living or as otherwise needed
including:

                       Age and developmentally appropriate daily and community living skills,
                       Nutritional services,
                       Food planning, grocery shopping, cooking, and eating,
                       Personal hygiene and grooming skills,
                       Household maintenance, including house cleaning and laundry,
                       Money management and budgeting,
                       Shopping for daily-living necessities,
                       Community awareness and current events,
                       Identification and use of social and recreational skills,
                       Use of available transportation, and
                       Personal responsibility.

Work readiness activities (excepting skills related to a specific vocation, trade, or practice):

                       Work related social and communication skills;
                       Work related personal hygiene and attire;
                       Work related time management; and
                       Other related skills preparing the recipient to be employable.

Psychosocial Skills Training must have an ongoing process to ensure that recipients participate
in the development and periodic revision of program curricula as appropriate to their age and
developmental       capacity.     Training       occurs     after     school       and       during
weekend hours when this meets the recipient's needs. The staff must be present at all times
during the course of the group skills training. A group recreational outing is not billable for this
service.

NOTE: Anger management and alternatives to aggressive behavior are more appropriately
addressed in Group Counseling and must not be provided as part of this service.


Place of Service

This service must be provided in a location, which ensures confidentiality. Locations including,
but not limited to retail outlets, libraries, sporting events, etc. do not meet guidelines for
confidentiality and may not be used for groups. Individual skills training could be provided in
locations, if related to the ISRP, and conducted in such a manner as to promote normalization
and prevent stigmatization. This service shall not be provided at a site that serves as a group
living environment, such as a board and care facility, group home or apartment building that
serves as a residence for more than one MHR recipient.

                                       Page 29 of 39                                     Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                    04/01/09
                                REPLACED:                                                  06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

Staffing Requirements

The service must be provided under the supervision of an LMHP with a minimum of two (2)
years experience providing services to children, youths and their families. The services must be
provided by one of the following:

             An LMHP,
             An MHP, or
             An MHS.
Group size may not exceed eight (8) recipients for any single skill building activity.

Service Authorization Periods

The training material must be organized into a specific number of sessions, not to exceed twenty
(20) sessions, (services that meet the definition of medication management should be provided
by staff credentialed to offer that service) for each topic area (curriculum). A recipient would
normally participate for six (6) to eighteen (18) months.

               Interim – None
               Initial – ninety (90) days
               Reassessment – up to ninety (90) days


Optional Services

Optional services may only be offered by providers that have been certified by Medicaid
Behavioral Health Section to provide this service. Refer to Section 31.3 for the optional services
certification process.


Parent/Family Intervention (Intensive) (Youth Only)
Service Definition
Parent/Family Intervention (Intensive) (PFII) is a structured service involving the recipient and
one (1) or more of his/her family members. It is an intensive family preservation intervention
intended to stabilize the living arrangement, promote reunification, or prevent utilization of out
of home therapeutic placement (i.e., psychiatric hospitalization, therapeutic foster care) for the
recipient. This service focuses on the family; and is delivered to children and youths primarily in
their homes. Therefore, PFII is not appropriate for recipients whose families refuse to participate
or to allow services in the home. This service utilizes specific interventions, which must be
documented in the recipient‘s ISRP. Evidenced based strategies should be used when applicable
and tailored to address the recipient‘s and family‘s needs.
                                      Page 30 of 39                                      Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

The goals of PFII include but are not limited to:

               Diffusing the current crisis, evaluate its nature and intervene to reduce the
               likelihood of a recurrence;
               Ensuring the linkage to needed community services and resources;
               Ensuring the clinical appropriateness of services provided; and
               Improving the recipient‘s ability for self care (age appropriate), as well as the
               parent‘s or legal guardian‘s capacity to care for their children.


Program Requirements

To qualify for this service, the recipient must be at risk of out of home therapeutic placement due
to his/her emotional/behavioral disorder or reintegrating from out of home placement and score a
Level five (5) or six (6) on the CALOCUS.

Services are based on the individual‘s unique needs, strengths and family culture with the goal of
self-sufficiency. Documentation should incorporate the child/family‘s strengths and weaknesses
and reflect their unique culture and values. Outcomes should include evidence of a decreased
reliance on the formal system of providers and an increased reliance on family resources and
informal supports.

This is a team-based service and there must be evidence of team coordination and interaction
with the recipient and his/her family as a single organizational unit. A recipient would normally
receive services at this intensive level for a ninety (90) to one hundred eighty (180) day period,
depending on medical necessity, with a period of less intensive services to follow.

Services are individually designed in partnership with the recipient and his/her family to
minimize intrusion into the family and maximize the skills necessary to increase independence.
Telephone contact and collateral contacts (face-to-face and telephone) are allowed subject to the
overall face-to-face service ratio referenced below. The contacts must be relevant to the ISRP
and appropriately documented. PFII is comprehensive and includes all other rehabilitative
services except initial assessment and medication management.

If a provider does not offer PFII services, the recipient/family must be given a list of PFII
providers from which to choose a provider. The PFII provider must do all service planning until
the recipient is no longer in need of intensive services. The referring provider may only provide
the initial assessment, reassessment and medication management. At the completion of PFII
services, the recipient may choose to return to the referring provider. Since a recipient has the
freedom to choose providers, he/she may choose to refuse the PFII referral. The provider should
document the effort to educate the recipient and family regarding the need for the intensive
services provided by PFII.


                                      Page 31 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

Service parameters must encompass the following:


Duration of Treatment

Services normally range from ninety (90) to one hundred eighty (180) days, depending on the
presenting stabilization needs of the recipient and family. Providers may request a service
extension in exceptional cases. However, the vast majority of recipients served should complete
this phase of treatment within the allotted time range.

Intensity of Service

Services typically follow a course of treatment with intensive and frequent services in the early
phases of treatment. A minimum of sixteen (16) contacts must occur within the first month. For
the second and third months of services, an average of ten (10) contacts per month must occur. It
is the expectation that service frequency will gradually reduce over the last two (2) months. All
service contacts are subject to the face-to-face and community ratios described below.

Face-to-Face Contact and Location of Service

The majority of the service is provided face to face with the recipient (no less than sixty (60%)
percent) of contacts over the span of the authorization period) in the home or other natural setting
(no less than eighty percent (80%) of contacts over the span of the authorization period). The
service shall be available at times convenient to the recipient/family needs and requests,
including evening and weekends.

Team Caseload

Each team of three staff may not exceed a caseload of twelve (12) families at any given time.
Staff to family ratio takes into consideration required evening and weekend coverage, crisis
service needs, and geographical coverage.


Crisis Management

The provider must demonstrate the presence and application of policies and procedures
addressing the following:

       Availability
             The PFII team must be available for 24/7 telephone response and mobile outreach
             response to the recipient‘s home, school, etc., as needed. Coordination of care,
             resources and supports must be provided for each crisis episode.

                                      Page 32 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                              PAGE(S) 39

       Planning and Management
             Comprehensive crisis protocols, including triage for psychiatric hospitalization
             must be developed, implemented and modified as needed. A crisis needs
             assessment with the participation of the family, must be completed for all
             recipients and families. The written crisis plan must clearly define intervention
             steps, incorporate natural supports and must not rely exclusively on professional
             resources. The plan must be filed in each recipient record and be re-evaluated and
             modified with each crisis that occurs.

Family Involvement

Services are family-driven, and they are an equal partner in all aspects of the service delivery.
This includes involving the recipient/parents in strength based treatment planning. It also
includes the recipient/parents involvement in the service planning meetings and signatures on the
ISRP.

Team Case Coordination
There must be documentation of team coordination on each case at least once per week. This is
covered under the PFII fee and is not a separate billable service. A structured weekly time
should be set aside for team case coordination and review. All changes in the ISRP must be
documented.
The team approach should incorporate flexible services and a capacity to address concrete
therapeutic and environmental issues in order to stabilize the family situation as soon as possible.
The best practice of such an approach should allow the child and family to view the services as
delivered by a single organizational unit or team.

Comprehensive Mix of Services
PFII includes a comprehensive set of services designed to meet the mental health needs of the
recipient and family. Services must be uniquely matched to each individual‘s presenting needs.
Services shall include at a minimum:

               Crisis management,
               Intensive care coordination,
               Identification of needed community resources,
               Linkage to such resources,
               Follow-up to determine adequacy and appropriateness of resources,
               Individual and family counseling/therapy,
               Skills training, including all skills training delineated in the Community Support
               service description,
               Behavioral management,

                                      Page 33 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39

               Development of behavior management plans,
               Training of behavior management skills, and
               Monitoring, updating and adapting behavior management plan.


System Collaboration

Services for the recipient must address coordination and collaboration with family and
significant others, and with other professional systems of care, including but not limited to
education, OAD, OCDD, OJJ and OCS when appropriate.

The provider must take a lead in facilitating collaborative meetings, which include the recipient
and family, in the various environments where the formal and informal supports are located.

The development of working relationships with other systems of service (i.e., schools, OJJ and
OCS) may include written agreements such as memorandums of understanding, referral
networks, etc. Such tools demonstrate the provider‘s capability and practice of providing
services in the various related environments, including but not limited to homes (birth, relatives,
adopted, foster), schools, temporary holding facilities, homeless shelters, etc.

Any requests for prior authorization of services for recipients involved in other systems of care
shall include a copy of the treatment plan developed by that entity. This will ensure a full range
of needed services are provided and prevent duplication of effort.


Staffing Requirements

PFII is provided by a team including the recipient, his/her family, significant others and a
minimum of the following provider staff in each team (total of three (3) staff per team):

             One (1) full time team leader who is an LMHP with a minimum of three (3) years
             experience working with children, youths and their families; and
             Two (2) additional full time staff who must be one of the following:
                  An LMHP;
                  An MHP; or
                  An MHS.

No more than one staff member per team may be an MHS. No more than thirty three percent
(33%) of contacts per authorization period may be provided by an MHS. Staff assigned to a PFII
team must be exclusive to this team and provide no other services.




                                      Page 34 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               04/01/09
                                REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                           PAGE(S) 39

Service Authorization Periods

           Interim – None
           Initial – up to ninety (90) days (review and/or authorization may be more frequent)
           Reassessment – up to ninety (90) days (review and/or authorization may be more
           frequent)



Psychosocial Skills Training – Group (Adult)

Service Definition

Psychosocial Skills Training (PSR) - Group (Adult) is a face-to-face therapeutic program based
on a psychosocial rehabilitation philosophy that assists persons with significant psychiatric
disabilities to build the skills necessary to live successfully in the natural environments they
choose.

This service should achieve the following outcomes:
               Enable the recipient to become a productive member of society, earn a wage, and
               live as independently as possible, thereby, reducing the recipient's dependency on
               state and/or federally funded programs.
               Achieve the restoration, reinforcement, and enhancement of skills and/or
               knowledge necessary for the recipient to achieve maximum reduction of his/her
               psychiatric symptoms.
               Minimize the effect of mental illness.
               Maximize the recipient's strengths.


Clinical Exclusions

The provider shall not admit any recipient who poses a documented health and safety risk to
himself/herself, to other recipients, or for whom the provider cannot provide the necessary care.


Program Requirements

A Psychosocial Skills Training program must be open and available for recipient participation no
less than twenty-five (25) hours a week, and no less than five (5) hours per day. The service
duration shall be based on individual need and as authorized on the recipient‘s ISRP. Sessions
must be offered at times to meet the recipient‘s needs, including evenings and weekends.


                                     Page 35 of 39                                  Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39


No collateral contact or other non-face to face service is billable under this service description.
A group recreational outing is not a billable service.

Psychosocial Skills Training teaches skills necessary for the recipient to succeed in his/her
environment including but not limited to:

   Daily and community living skills:
                   Nutritional services,
                   Food planning, grocery shopping, cooking, and eating,
                   Household maintenance, including house cleaning and laundry,
                   Money management and budgeting,
                   Shopping for daily-living necessities,
                   Community awareness and current events,
                   Identification and use of social and recreational skills,
                   Use of available transportation, and
                   Personal responsibility.
   Socialization skills:
                       Communication,
                       Interpersonal relationships, including those with roommate(s) and
                       neighbors,
                       Problem solving/conflict resolution,
                       Management of sensory input and stress,
                       Natural support system development, and
                       Self-directed engagement in community social activities (development of
                       a social-recreational plan for the recipient).
                       Decision-making skills.
   Adaptation skills:
                        Identification of behaviors that interfere with performance;
                        Development of interventions to alleviate problem behavior,
                        including coping with symptoms of mental illness that affect the person's
                        ability to successfully work and/or attend school;
                        Development of capacity to follow directions and carry out
                        assignments; and
                        Acquisition of appropriate work habits.
   Development of leisure time interests and skills.

   Symptom management skills - focusing on day-to-day management of symptoms.
   (Technical medication training should be provided under the medication management
   service).

                                      Page 36 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  04/01/09
                                REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                            PAGE(S) 39


   Identification and management of symptoms of mental illness.

   Compliance with physician's medication orders.

   Education in mental health/mental illness:
                    Management of symptoms of mental illness to minimize the negative
                    effects of psychiatric symptoms which interfere with the recipient's daily
                    living, financial management, personal development, and community
                    integration (services that meet the definition of medication management
                    should be provided by staff credentialed to offer that service); and
                    Developing skills necessary for the recipient to comply with prescribed
                    medications.

   Work readiness activities as part of a clubhouse model (excepting skills related to a specific
   vocation, trade, or practice):

                      Work related social and communication skills;
                      Work related personal hygiene and attire;
                      Work related time management; and
                      Other related skills preparing the recipient to be employable.

This service must have an ongoing process to ensure that recipients participate in the
development and periodic revision of program curricula. The curriculum must be designed to
improve or maintain the recipient's ability to function in normal social roles and ensure that the
methods and materials utilized are age and developmentally appropriate and culturally relevant.

It must utilize one (1) or more of the following three (3) Medicaid Behavioral Health Section
designated psychosocial rehabilitation program models or combine elements from each in a
clearly delineated program approach:

                      Boston Psychiatric Rehabilitation Model,
                      Clubhouse Model, or
                      Social Skills Training Model.

Training material must include activities that will allow each recipient to practice the skill(s)
taught during the group session and in natural settings. This will allow the recipient to further
develop and integrate the skill taught. The training material must be organized into a specific
number of sessions for each topic area (curriculum). If a recipient completes a curriculum but
needs additional training, community support should be used during or after the group sessions
as a more individualized method of training.



                                     Page 37 of 39                                     Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                    04/01/09
                                REPLACED:                                                  06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                               PAGE(S) 39


If a provider does not offer PSR services, the recipient must be given a list of PSR providers
from which to choose a provider. The name of the provider of choice is placed on the ISRP
along with other requested services. The authorization staff will authorize all medically
necessary services on the ISRP, by provider and send the prior authorization decision for each
service to the appropriate provider.
It is the responsibility of the community support worker to ensure services are coordinated
between the two (2) providers. Providers should develop ongoing working relationships with
PSR providers in their area that may include the development of a memorandum of
understanding.

Place of Service

Services must be provided in a location that ensures confidentiality. Locations including, but not
limited to retail outlets, libraries, sporting events, etc. do not meet guidelines for confidentiality
and may not be used for groups. Individual skills training could be provided in such locations, if
related to the ISRP and conducted in a manner as to promote normalization and prevent
stigmatization.
This service shall not be provided at a site that serves as a group living environment, such as a
board and care facility, group home or apartment building that serves as a residence for more
than one MHR recipient. No collateral contact or other non face-to-face service is billable under
this service description. A group recreational outing is not a billable service.

Staffing Requirements

All staff providing direct services must have documented orientation to the psychosocial
rehabilitation model used.

This service shall be furnished under the supervision of an LMHP who is on site a minimum of
50 fifty percent (50%) of the service operating hours. The supervising LMHP shall be a
Certified Psychosocial Rehabilitation Practitioner (CPRP) as designated by the Commission for
Psychiatric Rehabilitation Certification through United States Psychiatric Rehabilitation
Association (USPRA). If the LMHP is not a CPRP, he/she must be eligible for certification with
a written plan for achieving certification. This must be accomplished within twelve (12) months
of the provider‘s certification or within twelve (12) months of being hired.

Providers must submit information requested by the Bureau regarding the certification status of
each LMHP supervisor. Failure to do so may result in administrative sanctions or decertifying
the program. If an LMHP does not pass the certification exam, a written corrective action plan
must be submitted to the Medicaid Behavioral Health Section within thirty (30) calendar days of
the notification.

                                       Page 38 of 39                                    Section 31.1
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 04/01/09
                                REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.1: SERVICES                                                             PAGE(S) 39


For more information regarding the CPRP certification process and exam, visit the USPRA
website at www.USPRA.org.

The following individuals may provide psychosocial skills building (group):
              An LMHP or
              An MHP or MHS under the supervision of an LMHP.

The program must have a minimum of one (1) direct service staff for eight (8) recipients at all
times of active program participation.

Group size may not exceed fifteen (15) recipients for any single skill building activity.
All staff providing direct services must have completed:
                The associated population-specific orientation, and
                Orientation to the psychosocial rehabilitation model used in the program.


Service Authorization Periods

               Interim – None
               Initial – ninety (90) days
               Reassessment – up to ninety (90) day

A recipient would normally participate in Psychosocial Skills Training Group (Adult) for six (6)
to eighteen (18) months.




                                     Page 39 of 39                                   Section 31.1
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

               SERVICE ACCESS AND AUTHORIZATION

The Bureau must prior authorize all requests for services to ensure that the medical
necessity criteria are met. Services provided without prior authorization will not be
reimbursed. Prior Authorization is a function performed through Service Access and
Authorization (SAA). The review process may include a medical review conference.
This conference is a face-to-face or telephone meeting with a recipient’s psychiatrist for
the purpose of reviewing clinical aspects of a recipient’s care following an eligibility or
reauthorization request.

Requests for Reauthorization should be submitted 14 days prior to the expiration of the
current authorization to avoid lapse in services and to assure timely processing of
requests. Providers must use approved documents and follow the authorization process
established by the Bureau (Appendix F). All information sent to the SAA unit is date
stamped and logged into Utilization, Tracking, Oversight, and Prior Authorization
system (UTOPiA) the day it is received. Information received after 3:00 p.m. is
stamped and logged into UTOPiA the following business day.

Providers will receive written notification of the authorization decision via electronic
transmission through Mental Health Rehabilitation Services Information System
(MHRSIS). Recipients will receive written notification of the authorization decision.
A request for additional information will be sent to providers if required information is
missing (such as Social Security number, address, signature page, etc.). The SAA staff
will contact the provider for this information. The contact will be documented as a
request for more information. If the additional information is not received by the
14thcalendar day after the receipt of the original request, the request will be denied.

If it is determined at any point during the SAA process that the recipient does not
qualify for services, the provider shall refer the recipient to his/her primary care
physician, Mental Health Clinic (MHC) or other outpatient mental health services with
copies of all available medical and social information. The referral must be
documented in MHRSIS.

The provider requesting authorization for a new recipient will follow phases one and
two. Providers requesting a reauthorization will follow Phase Three. There are seven
additional SSA activities detailed below which require providers to submit information
to the SAA unit. Providers must submit the required documentation with each request.

To obtain Mental Health Rehabilitation (MHR) forms, service authorization guidelines,
the fee schedule, service areas and denial codes visit the Medicaid Behavioral Health
Section (MBHS)/MHR website. If assistance is needed, contact a network services
representative. Refer to Appendix G for website address and network services contact
information).


                                        Page 1 of 9                          Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

Service Access and Authorization Process

Phase One: Screening for MHR Eligibility

When a recipient requests services, an initial screening must be completed to determine
whether the recipient meets the medical necessity criteria for services. Recipient data
must be entered into MHRSIS.

 Based on the results of the screening, the Licensed Mental Health Professional
(LMHP) shall make one of two determinations:
     •   The recipient does not meet medical necessity criteria and is referred to
         appropriate community resources. The referral must be entered in MHRSIS
         before the record is closed, or
     •   The recipient seems to meet eligibility criteria and will move onto phase
         two.

Phase Two: Determining Eligibility and Developing an Individual Service
and Recovery Plan (ISRP)

If the recipient seems to meet medical necessity criteria, the provider continues the
eligibility process, which includes the following:
      •      Obtaining a Freedom of Choice form signed by the recipient;
      •      Opening the case in MHRSIS and completing a Client Data Form;
      •      Conducting the Initial Assessment (including rating the Level of Care
             Utilization System (LOCUS) or Child and Adolescent Level of Care
             Utilization System (CALOCUS));
      •      Developing the initial ISRP, this must address the recipient’s immediate
             needs. The recipient must participate in the development of the initial ISRP
             as indicated by a signature on the ISRP (all children six and older must sign
             the plan);
      •      Developing the crisis plan, which must address areas in which the recipient
             is at risk of harm;
      •      Reviewing the electronic clinical data inquiry (e-CDI) data, if available.
             The treating psychiatrist and LMHP must review, sign, and date the
             printout;
      •      Entering the LOCUS or CALOCUS rating into MHRSIS;
      •      Submitting a data file before sending an authorization request to SAA; and
      •      Submitting the appropriate documentation as detailed in Appendix F.

Initial assessment data is collected and documented on the Initial Assessment form and
must be completed within 30 calendar days following the eligibility screening.



                                        Page 2 of 9                         Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9
Extensions beyond the 30 day assessment period may be granted on a case-by-case
basis, under exceptional circumstances at the discretion of the Medicaid Behavioral
Health Section. Requests for extensions should be thoroughly documented and directly
related to the reason for the delay. (Example: a 15 day extension is requested because
the recipient was hospitalized for 15 days.)

To establish eligibility for the program, the following must be met to receive an initial
authorization:
     • Recipient/family agrees to receive services from the provider as indicated by
          a signature on the Freedom of Choice form;
     • Recipient meets the medical necessity criteria;
     • Recipient has a LOCUS or CALOCUS level of four or above (level three or
          above if returning to community living from structured residential settings
          under Department of Children and Family Services (DCFS) or Office of
          Juvenile Justice (OJJ) authority; and
     • Documentation indicates a thorough and accurate assessment which supports
          the diagnosis and LOCUS or CALOCUS level.

Approval for Eligibility

If the request meets the medical necessity criteria for eligibility, the initial authorization
will begin on the date the screening is completed. The provider will receive the
approval notice electronically through MHRSIS. Authorization letters are mailed to
recipients.

Denial for Eligibility

An eligibility request may be denied if the recipient does not meet medical necessity
criteria. The medical review psychiatrist may evaluate denied requests. The denial
notice will include the recipient’s appeal rights. If the request is denied, the initial
authorization will not be issued. The denial letter is mailed to the recipient and the
provider is notified.

Phase Three: Requesting Continued Services

To request continued services, the provider must submit required information. The
MBHS will consider several factors related to the recipient’s need for continued
services. The provider must:
      • Conduct a reassessment, including rating the LOCUS or CALOCUS;
      • Enter the LOCUS or CALOCUS rating into MHRSIS before submitting the
          authorization request;




                                         Page 3 of 9                            Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

     •    Update the ISRP;
     •    Review, sign, and date the e-CDI printout (LMHP and psychiatrist);
     •    Ensure the request includes all of the required documentation and signatures;
     •    Submit a data file;
     •    Submit any other information requested by MBHS.

The reauthorization request is submitted to the SAA unit. SAA staff may review
reassessment data and the ISRP to ensure services are delivered and that anticipated
progress is made toward the established goals or the ISRP has been adjusted. This step
allows the authorization staff to verify the medical necessity of ongoing care. The
submitted information is reviewed according to the following continued stay criteria:

Adult Criteria:
    • Clinical evidence indicates a persistence of the problems that necessitated the
         provision of MHR services;
    • Clinical evidence indicates that a less intensive level of care would result in
         exacerbation of the symptoms of the individual’s mental disorder and clinical
         deterioration;
    • The ISRP has been developed, implemented and updated based on the
         individual recipient’s clinical condition and response to treatment, as well as
         the strengths and availability of natural supports, with realistic goals and
         objectives clearly stated;
    • The recipient is actively engaged in treatment as evidenced by regular
         participation in services as scheduled;
    • Progress is evident that the individual’s disorder can be expected to improve
         significantly through medically necessary, appropriate therapy and that the
         individual is able to benefit from the therapy provided; and
    • There is clinical evidence of symptom improvement. If there has been no
         improvement, the ISRP may be reviewed and the frequency, amount or
         duration of services may be adjusted to a clinically appropriate level as
         determined by the Bureau.

Child/Adolescent Criteria:
     • Clinical evidence indicates a persistence of the problems that necessitated the
        provision of MHR services;
     • Clinical evidence indicates that a less intensive level of care would result in
        exacerbation of the symptoms of the child’s mental or behavioral disorder
        and clinical deterioration;
     • The ISRP has been developed, implemented and updated based on the
        individual child’s clinical condition and response to treatment, as well as the
        strengths and availability of natural supports, with realistic goals and
        objectives clearly stated;


                                       Page 4 of 9                         Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

     •    The recipient and family are actively engaged in treatment as evidenced by
          regular participation in services as scheduled;
     •    Progress is evident that the child’s mental or behavioral disorder can be
          expected to improve significantly through medically necessary, appropriate
          therapy and that the child is able to benefit from the therapy provided; and
     •    There is clinical evidence of symptom improvement. If there has been no
          improvement, the ISRP may be reviewed and the frequency, amount or
          duration of services may be adjusted to a clinically appropriate level as
          determined by the Bureau.

In addition, the following specific information should be supplied with the request,
validating that the above criteria have been met:
     • The current requested services, the previous authorization request, and the
          amount of services delivered in the previous authorization period reflect the
          ongoing need for the types and level of services;
     • The total length of stay in the program;
     • The number of crises or hospitalizations. A high number of crises may
          provide justification for a higher number of services and fewer crises may
          result in justification of a lower number of services;
     • Symptoms and medication in comparison to the previous quarter;
     • The LOCUS or CALOCUS level decreasing or there is an explanation as to
          why the level has not decreased;
     • The current and previous ISRP goals, objectives, and interventions address
          the needs identified in the reassessment;
     •     The provider has clearly documented changes in the recipient’s status;
     • The recipient/family participated in defining recovery goals and objectives
          which are documented in the plan as indicated by recipient/family signature
          (all children six years and older must sign plan);
     • Requested services are age, cognitively, culturally or developmentally
          appropriate;
     • Evidence based – best practice interventions are being provided;
     • Symptoms, diagnosis and/or functional impairment matches services
          requested and/or CA/LOCUS score;
     • Medication(s) prescribed are pursuant to best practice;
     • The information on the reassessment correlates to the diagnosis listed;
     • The objectives are written in SMART (Specific, Measurable, Action-
          Oriented, Realistic and Time Limited) format;
     • Interventions must be specific and include the intervention method and
          frequency of contact;
     • Risk management issues have been identified and addressed;
     • The ISRP includes an individualized, recovery focused crisis plan and the
          initial discharge plan;


                                      Page 5 of 9                         Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

     •   All identifying information such as Social Security number, address,
         Medicaid number is present;
     •   A data file is submitted, and
     •   The appropriate documentation is submitted as detailed in Appendix F
         inclusive of all required signatures.

Approval for Continued Services

If the request for authorization meets the requirements stated above, the request for
services may be approved. Authorization letters are mailed to recipients. The provider
is sent the approval notice electronically through MHRSIS.

Denial for Continued Services

An authorization request may be denied if the recipient does not meet medical necessity
criteria. The medical review psychiatrist may evaluate denied requests. The denial
notice will include the recipient’s appeal rights. If the request is denied, the initial
authorization will not be issued. The denial letter is mailed to the recipient and the
provider is notified.

Other Service Access and Authorization Activities

Request for Revision

If a recipient needs additional services prior to the end of the authorization period, a
request to revise the authorization must be submitted to the SAA unit. The revision
request is reviewed according to authorization criteria that may include, but is not
limited to, the following:
       •     The recipient is a danger to self or others, and is at risk for displacement
             (i.e. psychiatric hospitalization, therapeutic out of home placement, or
             incarceration);
       •     Two-thirds of the current/active units approved by SAA have been utilized;
       •     Referrals for the appropriate and medically necessary specialty services
             have been made but the service(s) are not available;
       •     The request includes all of the required documentation and signatures;
       •     The provider has clearly documented changes in the recipient’s status;
       •     Risk management issues have been identified and addressed.

Approval of the Revision Request

If the request for authorization meets the requirements stated above, the request for
services may be approved. Approval letters are mailed to recipients. The provider is
sent the approval notice electronically in MHRSIS.

                                       Page 6 of 9                          Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

Denial of the Revision Request

The medical review psychiatrist may evaluate denied requests. The denial notice will
include the recipient’s appeal rights. The denial letter is mailed to the recipient and the
provider is notified.

Authorization of Emergency Services

To assure the quality and accessibility of services, a continuity of care procedure will
be followed for recipients being discharged from any 24-hour care facility when
discharge is dependent upon the availability of follow-up mental health services.

This may include, but is not limited to, discharges from juvenile detention facilities,
psychiatric hospitals or distinct part psychiatric units.

Emergency Authorization for New Recipients

To request an emergency authorization, the provider selected by the recipient must
participate in discharge planning with the facility. The provider must complete Phase
One and Phase Two of the SAA process. The SAA unit will render a decision within
one working day.

Emergency Authorization for Active Recipients

The provider must participate in discharge planning with the facility, taking care to note
the expiration date of the existing authorization. The provider shall submit a new
authorization request as outlined in phase three of the SAA process or submit a request
for revision on the date of discharge as appropriate. The SAA unit will render a
decision within one working day.

NOTE: No services may be billed while the recipient is a patient in a 24-hour care
facility except on the date of discharge. On the day of admission to a health care
facility, providers may not bill for services.

Recipient Transfer

For active recipients who choose a different provider, the authorization for the current
provider will be canceled. A new authorization will be issued to the newly selected
provider. The current authorization will be canceled on the day before the Freedom of
Choice is signed and dated. This process will prevent overlap in services. The new
provider should follow Phase Three of the authorization process to request services.




                                        Page 7 of 9                          Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9
The new provider must submit an authorization request within 30 days following the
date on the Freedom of Choice. Extensions beyond the 30 day assessment period may
be granted on a case-by-case basis, under exceptional circumstances at the discretion of
the Medicaid Behavioral Health Section. Requests for extensions should be thoroughly
documented and directly related to the reason for the delay.

       Example:
       A 15-day extension is requested because the recipient was hospitalized for 15
       days.

If the last date of service has been more than twelve months, the recipient must be
readmitted to the program. The provider must complete Phase One and Phase Two of
the SAA process before requesting an authorization for services.

Recipient Readmission

If a recipient requests to re-enter the program and selects a provider who had previously
provided services within the past twelve months, the provider must complete Phase
Three of the SAA process before requesting an authorization for services.

If the last date of service has been more than twelve months, the recipient must be
readmitted to the program. The provider must complete the Phase One and Phase Two
of the SAA process before requesting an authorization for services.

NOTE: An Initial Assessment will only be issued if a recipient has not received MHR
services within the past 12 months.

Reconsideration

If the provider does not agree with the decision of the SAA unit, reconsideration may
be requested. The provider must indicate that it is a “reconsideration”. The SAA Unit
will render a decision on the reconsideration request. If the request is approved, it will
not be backdated. The provider and recipient will be notified of the decision within 14
calendar days of the receipt of the request for reconsideration. If the request is denied,
the denial notice will include the recipient’s appeal rights.

Appeal Process

If the recipient continues to be dissatisfied with the decision, he/she may file an appeal
through the Division of Administrative Law/HH Section within 30 days of receipt of
the denial notice.




                                        Page 8 of 9                         Section 31.2
LOUISIANA MEDICAID PROGRAM       ISSUED:     03/01/11
                                 REPLACED:   04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.2: SERVICE ACCESS/AUTHORIZATION PAGE(S) 9

Provider Closure

Prior to the voluntary closure, the provider will notify all recipients of the pending
closure, provide a Freedom of Choice form to assist the recipient in choosing another
provider or other treatment resources. The provider should coordinate with the new
treatment resource to ensure the recipient has sufficient medication. Upon the
recipient’s written consent, the provider must make copies of the recipient’s record
available. The provider must complete the MHRSIS Closure Form and submit it to the
SAA unit. The SAA unit will monitor this procedure.

If the closure is involuntary, the provider shall assist recipients with transitioning to
other mental health services. This shall include the development of a transition plan for
each recipient.

NOTE: For more information regarding a provider closure, refer to Section 31.3 -
Changes or Events That Must Be Reported.

Re-establishing Services to Displaced Recipients Due to Disaster

When a situation is deemed a disaster by DHH, procedures may be established in
response to the disaster to ensure recipients have access to services that are medically
necessary to maintain continuity of care. Any procedures established by DHH shall be
consistent with program rules.




                                       Page 9 of 9                          Section 31.2
LOUISIANA MEDICAID PROGRAM         ISSUED:                                                  08/01/09
                                   REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                    PAGE(S) 11



           PROVIDER CERTIFICATION AND RECERTIFICATION

When applying for certification and enrollment, prospective providers must follow the process
described below.

The provider shall have a separate Medicaid provider number for each location where business is
routinely conducted and services are provided. This does not include those sites or locations that
meet the definition of an off-site service delivery location. Each site must be accredited.

NOTE: The provider must maintain a current policies and procedures manual as described in
Section 31.4 of this manual chapter. This manual must be made available to the Bureau upon
request.



Initial Certification and Enrollment

An initial provider certification and enrollment is required for applicants requesting:

    Certification and enrollment as an MHR provider
    Change in ownership

The Medicaid Behavioral Health Section and the fiscal intermediary conduct the initial provider
certification and enrollment reviews. The Medicaid Behavioral Health Section reviews the MHR
certification application to ensure the applicant meets MHR certification criteria. The Medicaid
Behavioral Health Section review may include at least one (1) on-site review. If the application
and site review meet certification requirements, the LA Medicaid enrollment applications are
forwarded to the provider enrollment unit at the fiscal intermediary for the enrollment review.

The fiscal intermediary reviews the completed LA Medicaid applications. If the applicant meets
the Medicaid enrollment criteria, a provider number will be issued. Failure to meet certification
and enrollment criteria or failure to follow the standard response timelines listed below may
result in a certification and enrollment denial and possible exclusion from the MHR program.




                                      Page 1 of 11                                        Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                               08/01/09
                                   REPLACED:                                             04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                    PAGE(S) 11

Initial Certification and Enrollment Applications

To obtain one (1) or more of the certification and enrollment applications, or if you have any
questions about the initial certification and enrollment process, you may contact a network
services representative by calling (225) 342-1203 or post your question on the MHR website,
www.mhrsla.org.

An applicant who elects to enroll with the department to provide MHR services shall apply to the
Bureau for certification. The applicant shall create and maintain documents to substantiate that
the applicant meets all prerequisites in order to enroll.

An applicant shall submit the following documents for certification:

      MHR initial certification application;
      Medicaid Basic Enrollment Packet for Entities/Businesses;
      Enrollment packet for the Louisiana Medical Assistance Program-Mental Health
      Rehabilitation;
      Enrollment packet for the Louisiana Medical Assistance Program-Physician, individual or
      group, if applicable.
      If the physician is already enrolled as a Medicaid provider, the Group
      Linkage/Unlinkage form must be completed.

The MHR Initial Certification Application includes required attachments, which are listed below:

       Proof of a request for accreditation and a copy of the completed application with a
       national accrediting body approved by the bureau and proof of payment to the accrediting
       body. Proof of full accreditation is required within nine (9) months of issuance of a
       Medicaid provider enrollment number;

       Proof of the establishment and maintenance of a line of credit from a federally
       insured, licensed lending institution in an amount equal to three (3) months of current
       operating expenses as proof of adequate finances. A budget showing actual or projected
       monthly expenses shall be attached. It is the MHR provider's responsibility to notify the
       bureau in the event that the financial institution cancels or reduces the upper credit limit.

Nonprofit agencies that have operated for five (5) years or more and have an un-qualified audit
report for the most recent fiscal year prepared by a licensed certified public accountant, which
reflects financial soundness of the nonprofit provider, are not required to meet this standard.

Government entities or organizations are exempt from this requirement.


                                      Page 2 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              08/01/09
                                   REPLACED:                                            04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                   PAGE(S) 11

          Proof of the establishment and maintenance of a general liability and a professional
          liability insurance policy with at least $1,000,000 coverage under each policy.
          Providers with more than one certified and enrolled site must have a separate policy
          for each location or each location must be identified on the provider‘s policy. The
          certificates of insurance for these policies shall be in the name of the provider and the
          certificate older shall be the Department of Health and Hospitals with the following
          mailing address:

For USPS mail delivery:                           For hand delivery or delivery via a parcel
                                                  service:

Medicaid Behavioral Health Section                Medicaid Behavioral Health Section
P.O. Box 91030                                    Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                        628 North 4th Street
                                                  Baton Rouge, LA 70802

The provider shall notify the Bureau when coverage is terminated for any reason. Coverage shall
be maintained continuously throughout the time services are provided and thereafter for a period
of one year. Government entities or organizations are exempt from this requirement.
       Corporations must provide current proof of business registration with the Secretary of
       State.

       Proof of an inspection and approval of the Office of Public Health (OPH), Sanitation
       Department for on-site and off-site locations.

       Proof of current inspection and approval by the Office of State Fire Marshal for on-site
       and off-site locations.
The provider must meet the minimum clinical competence criteria. To meet this requirement,
each organization must have documented clinical experience providing mental health services to
the population served by that organization. As such, each organization must have a combined
three (3) years (in one(1) year increments), experience providing mental health services to adults
or children/youth who meet the criteria for MHR as described in Section 31.0. If an organization
provides services to both youth and adult recipients, then 3 years clinical experience must be
demonstrated for each recipient population. Each organization providing Psychosocial Skills
Training (Adult) must also establish compliance with MHR CPRP staffing requirements.

The provider may be required to submit documentation such as staff resumes to document
compliance with this requirement. The provider shall employ sufficient staff to meet the
minimum clinical competency standard.



                                     Page 3 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              08/01/09
                                   REPLACED:                                            04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                   PAGE(S) 11


Optional Services Certification

An applicant who elects to offer one (1) or more optional services shall apply to the Bureau. The
applicant shall create and maintain documents to substantiate that the provider meets all
prerequisites for certification. The certification application is reviewed by the Medicaid
Behavioral Health Section to ensure the applicant meets standard criteria for providing the
services. The Medicaid Behavioral Health Section review may include at least one on-site visit.
A request to provide an optional service may be submitted when an applicant is applying for
initial certification and enrollment. If the request is submitted with an initial certification and
enrollment request, the optional service application and site review may be conducted at the
same time as the initial application and on-site review.

Optional Services Certification Applications

An applicant shall submit the following documents for certification:

            MHR Optional Services Certification Application
            Psychosocial Rehabilitation Certification Application
            Parent/Family Intervention Intensive Certification Application;
            Comprehensive implementation plan;

       For PSR:

            Proof of current inspection and approval of the site for psychosocial
            rehabilitation, by the Office of State Fire Marshal;
            Proof of current inspection and approval of the site, by the Office of
            Public Health; and
            Proof that the supervising LMHP is a Certified Psychosocial
            Rehabilitation Practitioner (CPRP). If the LMHP is not a CPRP, submit a
            written plan for achieving certification within twelve (12) months of the
            provider's certification or within twelve (12) months of being hired.




                                      Page 4 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                                 08/01/09
                                   REPLACED:                                               04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                      PAGE(S) 11

Certification Process

This process applies to initial certification, enrollment, and certification to provide one (1) or
more optional service.

Provider Application Review

Application and Site Review(s)

An applicant must mail or hand deliver the completed application (s) with required attachments
to the following address:
For USPS mail delivery:                             For hand delivery or delivery via a parcel
                                                    service:
Medicaid Behavioral Health Section                  Medicaid Behavioral Health Section
P.O. Box 91030                                      Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                          628 North 4th Street
                                                    Baton Rouge, LA 70802
An applicant shall undergo one (1) or more of the following reviews by the Bureau before
certification to provide mandatory or optional services to ensure compliance with provider
enrollment and operational requirements:

          an application review;
          a first site review; and if necessary
          a second site review.
The bureau may conduct a review of all application documents for compliance with MHR
requirements. The certification application must be approved by the Bureau prior to the first site
review of the applicant's physical location.

          If the application documentation furnished by the applicant is not acceptable, the
          applicant will be notified of the deficiencies.
                      The applicant has thirty (30) days from the date of receipt of the notice to
                      correct the document deficiencies. If the applicant fails to resubmit the
                      application or if the application is not approved, certification may be
                      denied.

          Following approval of the application, the applicant will have thirty (30) days to
          schedule the first site review.
                      If the applicant does not request a site visit within thirty (30) days,
                      certification may be denied.

                                       Page 5 of 11                                      Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                                  08/01/09
                                   REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                       PAGE(S) 11

                       If the applicant requests a site visit within thirty (30) days, a site review
                       may be scheduled.

          If the site meets all operational requirements, the certification request may be
          approved and forwarded to Provider Enrollment for further processing.

          If at the site review all operational requirements are not met, the provider will
           be notified of the deficiencies.
                         The applicant will have thirty (30) days from the date of receipt of the
                         notice to correct any deficiencies and request a second site review.
                         A second site review may be conducted if deemed necessary by the
                         bureau.
                         If the applicant fails to correct all deficiencies or to schedule a second site
                         review, certification may be denied.

Initial Certification Approval and Enrollment

The fiscal intermediary may enroll the prospective provider requesting initial certification once
the Bureau certifies compliance with all policy and operational requirements. All provider
enrollment requirements must be met before a Medicaid number is issued. If the prospective
provider fails to meet any certification requirements, they may not be enrolled as an MHR
provider. The applicant shall undergo the entire review process detailed above, if and when it
reapplies for certification.


Loss of Certification

There may be an immediate loss of certification if at any time the enrolled MHR provider fails to
maintain program requirements or accreditation status. The provider may not reapply for
certification for one year following the effective date of termination.


Discontinuation of Adult PSR and PFII Services

The provider must notify the Bureau of the intent to discontinue adult PSR or PFII services thirty
(30) days in advance, stating the reason for discontinuing the service. Prior to discontinuance,
each recipient must be offered a Freedom of Choice form from which to choose a new provider.




                                       Page 6 of 11                                       Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              08/01/09
                                   REPLACED:                                            04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                   PAGE(S) 11
Recertification

The Bureau may conduct a recertification review to ensure continued compliance with all MHR
regulations and policies. Certified providers shall apply for recertification annually. The
recertification application must be submitted ninety (90) days prior to the expiration of the
provider‘s current certification. The Bureau may conduct a recertification review to ensure
continued compliance with all MHR regulations and policies. The completed recertification
application and any required attachments must be submitted to:

For USPS mail delivery:                           For hand delivery or delivery via a parcel
                                                  service:
Medicaid Behavioral Health Section                Medicaid Behavioral Health Section
P.O. Box 91030                                    Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                        628 North 4th Street
                                                  Baton Rouge, LA 70802

Fax: (225) 342-1972 or (225) 342-1973 or Toll Free at (866) 427-2148

Required recertification application attachments may include but are not limited to the
accreditation report, copies of specific policies or procedures, and current staff information.
Required documentation may differ among providers based upon individual provider profiles.
An on-site review may be conducted to ensure compliance with all rules and requirements (see
Section 31.3).

Failure to Recertify

If the applicant fails to meet any recertification requirements and recertification is denied,, the
provider may be terminated and may not reapply for one year from the date of the notice of
termination.

Providers that fail to meet all requirements for recertification will receive a written notice
identifying the deficiencies. These deficiencies must be corrected within sixty (60) days of the
date of the notice. Failure to resubmit the application within sixty (60) calendar days and/or
failure to correct the deficiencies may result in sanction(s), including loss of certification and
termination from the program.




                                      Page 7 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                               08/01/09
                                   REPLACED:                                             04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                   PAGE(S) 11

Accreditation

Currently enrolled providers shall be accredited by a national accreditation organization for any
services for which Medicaid reimbursement will be requested. The Bureau shall only accept
accreditation from the national organizations listed below for the purposes of enrolling a
provider into the program. New providers must present proof of full accreditation by one of the
following national organizations within nine months following the certification date:

               The Council on Accreditation,
               The Commission on Accreditation of Rehabilitation Facilities, or
               The Joint Commission on Accreditation of Health Care Organizations.

All enrolled providers shall maintain accreditation status. Denial, loss of or any negative change
in accreditation status must be reported to the Bureau in writing within five (5) working days of
receiving the notice from the accrediting organization. The written notification shall include
information detailing a copy of the accreditation report and any related correspondence including
but not limited to:

               The provider‘s denial or loss of accreditation status;
               Any negative change in accreditation status;
               The steps and timeframes, if applicable, the accreditation organization is requiring
               from the providers to maintain accreditation.

Failure to notify the Bureau of denial, loss of or any negative change in accreditation status may
result in sanctions including loss of certification.

Accreditation approval letters and other written notifications from accrediting organization must
be sent to:

For USPS mail delivery:                            For hand delivery or delivery via a parcel
                                                   service:
Medicaid Behavioral Health Section                 Medicaid Behavioral Health Section
P.O. Box 91030                                     Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                         628 North 4th Street
                                                   Baton Rouge, LA 70802

Fax: (225) 342-1972 or (225) 342-1973 or Toll Free at (866) 427-2148

If at any time, a provider loses accreditation, an automatic loss of certification may occur. The
applicant may not reapply for one year from the effective date of the termination.

                                      Page 8 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                               08/01/09
                                   REPLACED:                                             04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                    PAGE(S) 11


Changes or Events That Must Be Reported

Certain changes or events must be reported in writing to Medicaid Behavioral Health Section or
fiscal intermediary at the addresses or fax numbers provided below. Since failure to comply with
this requirement may result in sanctions against the provider, it is advisable to confirm receipt of
the change reported.

Changes to Report to Fiscal Agent

A provider must submit a written statement requesting the provider enrollment unit to unlink a
psychiatrist when he/she discontinues employment with the provider. The change must be
reported to:
                       Molina Medicaid Solutions Provider Enrollment
                       Post Office Box 80159
                       Baton Rouge, LA 70898-0159

Changes to Report to Medicaid Behavioral Health Section

All changes reported to the Medicaid Behavioral Health Section must be faxed to Network
Services at (225) 342-1972 or (225) 342-1973 or Toll Free at (866) 427-2148 or using a Change
Report Form. To obtain MHR forms, visit the MHR website, www.mhrsla.org. If you need
assistance, contact a Network Services representative by calling (225) 342-1203.

Change of Address

A Change Report Form with the following attachments must be submitted to the Medicaid
Behavioral Health Section sixty (60) days prior to the first day of operation in the new location.
     Attachments
      Proof of an inspection and approval of the Office of Public Health, Sanitation Department
      Proof of current inspection and approval by the Office of State Fire Marshall
NOTE: The inspections may not be required if the provider is moving to a different office
location within the same building.

The provider must request an on-site review thirty (30) days prior to the first day of operation in
the new location. The Bureau may conduct a site review to ensure the location complies with
operational requirements. If the new site is approved, the Bureau will notify the fiscal
intermediary. Failure to comply with one or more of the requirements listed above may result in
sanction(s) against the provider.

                                      Page 9 of 11                                    Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              08/01/09
                                   REPLACED:                                            04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                   PAGE(S) 11


NOTE: Establishment of an additional office location is not a change. A new office location
requires a new provider certification application to be submitted.

Off-site Service Delivery Location

Providers who regularly use the same off-site service delivery location solely for the provision of
service delivery must notify the Bureau.

A Change Report Form with the following attachments must be submitted to the Medicaid
Behavioral Health Section sixty (60) days prior to the first day of operation in the new location.
The Medicaid Behavioral Health Section may conduct a site review.

   Attachments
      Proof of an inspection and approval of the Office of Public Health Sanitation Department
      Proof of current inspection and approval by the Office of State Fire Marshal

Change in Contact Information

Changes in the provider‘s telephone number (voice and fax) and provider‘s email address (s) on
file with the Medicaid Behavioral Health Section must be reported at the time the change is
made.

Change of Population

Changes in the population served must be reported at the time the change is made. The
provider‘s policies and procedures must be updated to reflect the change. MHRSIS data must be
updated must be reflected on the Freedom of Choice Form.

Changes of Ownership (CHOW)

A Change Report Form must be submitted to the Medicaid Behavioral Health Section sixty (60)
days prior to the change in ownership. The new owner must meet all certification requirements
as an MHR provider outlined earlier in this section. The Bureau will conduct a certification
review to ensure the new owner complies with all applicable federal and state regulations.

All recipients who are willing to continue receiving services from the new provider must
complete a Freedom of choice form.

NOTE: Services cannot be provided or billed by the new provider until all certification and
Medicaid enrollment requirements have been met.

                                      Page 10 of 11                                   Section 31.3
LOUISIANA MEDICAID PROGRAM         ISSUED:                                             08/01/09
                                   REPLACED:                                           04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.3: PROVIDER CERTIFICATION AND
RECERTIFICATION                                                                  PAGE(S) 11


Request to Discontinue Offering One or More Optional Services

If a provider chooses to discontinue offering an optional service, this change must be reported.
Prior to discontinuance, the recipient must complete a new Freedom of Choice form.

Agency Closures

If a provider makes the decision to voluntarily close, a Change Report Form must be submitted
to the Medicaid Behavioral Health Section thirty (30) days prior to the closure date. Notification
shall include the last date services will be provided and the location where recipient and
administrative records will be stored.

Staff

Changes in the employment of required staff, including LMHP, psychiatrist, and CPRP staff
must be reported at the time the change is made. A change includes hiring or firing a required
staff member. The provider must update the staff record in MHRSIS to reflect the change.

Accreditation Status

The provider must submit a Change Report Form to the Medicaid Behavioral Health Section
immediately upon notification of an accreditation loss. The provider must attach all
documentation (letter or reports) from the accrediting body as described above.

Insurance Coverage

The provider must immediately report cancellation of required insurance coverage.

Hours of Operation

The provider must report any changes in his/her hours of operation.


Reportable Events

        Accredited organizations must report information about significant or critical events
        including sentinel events, investigations, material litigation, and catastrophes. The
        provider must submit a Change Report Form to the Medicaid Behavioral Health Section.
        Any other occurrence, which affects compliance with certification requirements.


                                     Page 11 of 11                                   Section 31.3
LOUISIANA MEDICAID PROGRAM       ISSUED:                                             04/01/09
                                 REPLACED:                                           06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                PAGE(S) 10



                              PROGRAM OPERATIONS


General Provisions

The policies and procedures in this section specify requirements necessary to provide effective
services. The provider shall:

          Assume full responsibility for the delivery of all services, including those delivered
          through contracts, subcontracts, or consultant agreements.

          Ensure that services provided by contractors, subcontractors and consultants conform
          to all federal and state regulations regarding delivery and documentation of services
          and staff qualifications.

          Immediately report any suspected or known violations of any civil or criminal law to
          the appropriate authority and to the Bureau.

          Maintain written procedures and implement all required policies and procedures
          immediately upon acceptance of recipients for services.

          Request an expedited prior authorization review for any recipient whose discharge
          from a twenty-four (24) hour care facility is dependent on follow-up mental health
          services.

          Accept full responsibility to ensure that the office locations meet all applicable
          federal, state, and local requirements. The transferring of certifications to a new
          location is strictly prohibited.


Organizational Structure

The provider must maintain a current, functional organizational chart that defines the lines of
authority. The owner must designate an administrator who will have overall responsibility for
management of daily operations. The administrator or designee shall be accessible to the
Bureau‘s staff during all normal business hours.




                                     Page 1 of 10                                  Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                 04/01/09
                                 REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                    PAGE(S) 10




Cooperative Agreement

The provider agrees to cooperate with the Bureau with regard to recertification, monitoring of all
service related activities, and any function that may affect recipients. The provider also agrees to
require each contracted person or entity to sign an agreement to comply with the requirements
stated above. This may include interviewing the staff, recipients, family or other stakeholders
and observation of services.

The provider must have an identifiable governing body. The names and addresses of all members
of the governing body, their terms of membership, officers and their terms of office must be
documented. The governing body must:

       Include recipient and family representation.

       Hold formal meetings at least semi-annually to discuss programmatic and administrative
       operations, have written minutes of all formal meetings, and by-laws specifying
       frequency of meetings and quorum requirements.

       Have specific responsibility and authority over the policies and activities of the
       provider and:
          Ensure the provider's compliance with its articles of incorporation and/or its charter;
          Ensure the provider's continual compliance with all relevant federal, state, local, and
          municipal laws and regulations;
          Ensure that the provider is adequately funded and fiscally sound;
          Review and approve the provider's annual budget;
          Review and approve the annual external fiscal audit or audit review by a certified
          public accountant;
          Designate a qualified individual, based on the owner‘s recommendation, to act as
          administrator, delegate sufficient authority to this person to manage the agency, and
          annually evaluate the administrator's performance; and
          Formulate and annually review, in consultation with the administrator, written
          policies concerning the provider's philosophy, goals, current services, personnel
          practices, job descriptions and fiscal management.




                                       Page 2 of 10                                   Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                               04/01/09
                                 REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                  PAGE(S) 10

Policy Manual

The provider shall develop, maintain, and implement a written internal policy manual. The
provider must document that staff has been trained on the policy manual and make it available to
all staff. The manual must be made available to the Bureau and recipients upon request. The
manual must include the following:

    A policy governing creation and retention of administrative and personnel records;

    A policy to utilize the current MHRSIS (or its successor) system to include accurate, current
    provider staff and recipient information;

    Written procedures for maintaining the security and the confidentiality of recipient records;

     A comprehensive training policy for all employees, volunteers and students which meets
     specified requirements;

     A brief description of services provided;

     A policy and procedure for hospitalization that conforms with the Single Point of Entry
     (SPOE) policy and procedure;

     A procedure for referrals to services not offered by the provider, including PFII and PSR;

     A procedure for subcontracting optional services;

     A policy for adhering to Americans with Disabilities Act (ADA) guidelines;

    An operations policy that includes a mission statement, program philosophy, and goals of
    the provider;

    A complaint resolution procedures, including DHH as the final point of resolution;

    A policy and procedure regarding abuse, neglect, extortion or exploitation;

    Providers must have a policy that clearly defines abuse, neglect, extortion and exploitation
    of children and adults. All such policies and definitions must be in accordance with
    applicable state and federal laws, including, but not limited to the following:




                                     Page 3 of 10                                    Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                             04/01/09
                                 REPLACED:                                           06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                PAGE(S) 10

                  LSA-R.S. 14:403.2 et seq. (or subsequent updates);
                  LSA-Ch.C Art. 601 et seq. (or subsequent updates).
                  LSA-R.S. 40:2009.13 et seq. (or subsequent updates);

Providers must have a procedure for reporting suspected cases of abuse, neglect, extortion or
exploitation as required by law. The procedure must include the mandatory reporting by staff
of any suspected cases of abuse, neglect, extortion or exploitation. A staff member,
subcontractor, volunteer or intern who witnesses, has knowledge of, or otherwise has reason to
suspect that such an incident may have occurred must report the incident to the appropriate law
enforcement and state agencies such as Office of Community Services (OCS), Child Protection,
Adult Protective Services, and the Bureau. This includes incidents that occur in the provider
offices as well as situations that may arise outside the office.

Providers must also have an internal procedure to investigate and report such        incidents
allegedly committed by an employee. The procedure shall include, at a minimum, the following:

            Steps to take to report the incident to the appropriate law enforcement and state
            agencies such as the OCS, Adult Protective Services, and the Bureau.
            Any allegation of abuse, neglect, extortion or exploitation lodged against an
            employee must be reported to the administrator, and the administrator must
            cooperate in any investigation of the incident.
             Individuals under investigation are not to be part of the investigation team.
            Individuals under investigation are prohibited from working or having any contact
            with the recipient who made the allegation.
            The findings of the investigating team are to be reviewed by the appropriate
            administrative level and forwarded to the governing body.
             In substantiated cases of neglect, appropriate action must be taken to prevent a
            reoccurrence.
            In substantiated cases of abuse, extortion or exploitation, the employee must be
            terminated.
            Steps to be taken for referral and reporting to appropriate licensing board.

   Employment and personnel policies;

   Each provider must have written employment and personnel policies, which includes job
   descriptions for all positions that specify duties, qualifications, and competencies. It must
   also describe the hiring policies and practices including the following:




                                     Page 4 of 10                                  Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                  04/01/09
                                 REPLACED:                                                06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                    PAGE(S) 10


         Prevention of discrimination based on race, color, religion, sex, age, national origin,
         disability, disabled veteran, or any other non merit factor.
         Provision for recruitment and employment of recipients of mental health services and
         family members of children with emotional/behavioral disorder.
         A description of the procedure for employee evaluation and promotion.
         A procedure for disciplinary action, termination, and hearing of employee grievances.
         A procedure for maintenance of time and attendance logs for all employees and
         contractual staff.
         A procedure for the creation and retention of personnel records.
         A procedure for conducting Tuberculosis (TB) Tests. Each provider must coordinate
         processes to reduce the risk of such infections in recipients and staff. Skin testing
         procedures should be made part of the provider‘s infection control program. All
         persons, prior to or at the time of employment shall be free of TB in a communicable
         state.

Any employee who has a negative Mantoux skin test for TB shall be retested annually in order to
remain employed. Any employee who has a positive Mantoux skin test must provide evidence
of a normal chest X-ray, a statement from a physician certifying that the individual is non-
infectious if the chest X-ray is other than normal or completion of an adequate course of therapy
as prescribed by a licensed physician, if active TB is diagnosed. Any employee who has a
positive Mantoux skin test must provide an annual physician‘s statement as evidence that they
are free of TB in a communicable state.

   Policies and procedures regarding personal safety of staff while providing services;

   A policy on criminal background checks;

Providers must conduct criminal background checks through the Louisiana Department of Public
Safety, State Police on all employees prior to employment. If the results of any criminal
background check reveal that the employee was convicted of any offenses against a child/youth
or an elderly or disabled person, the employer shall not hire and/or shall terminate the
employment of such person. In the case of an individual with a criminal background record
involving other offenses, the provider should exercise caution and good judgment in conjunction
with their liability insurance carrier regarding hiring that individual. The provider shall not hire
an individual with a record as a sex offender nor permit these individuals to work for the
provider as a subcontractor.

If the provider offers services to children/youth, the background checks must be performed as
required by R.S. 15:587.1 and R.S. 15:587.3 et seq.




                                       Page 5 of 10                                   Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                 04/01/09
                                 REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                    PAGE(S) 10

To avoid delays in processing the background check, the form must be completed by the MHR
provider with "employer‖ selected. This will produce a statewide check. If the individual
resided or was employed in another state, that state needs to be checked as well. If the healthcare
provider works with children, then instead of selecting "employer" on the form, "working with
children" should be selected in order to comply with Louisiana statute, LSA RS 15.587.3.

   A policy on drug testing;

The provider shall have a policy to ensure an alcohol and drug-free workplace and a workforce
free of substance abuse. The policy must include:

       A pre-employment drug screen before an offer of employment is made. A prospective
       employee who tests positive for the presence of illegal drugs in the initial screening shall
       be eliminated from consideration for current employment.
       A provision prohibiting employees from reporting for work or performing work with
       alcohol, illegal drugs, controlled substances, or designer (synthetic) drugs present in their
       bodies.
       A prohibition from illegal use, possession, dispensation, distribution, manufacture, or sale
       of controlled substances, designer (synthetic) drugs, and illegal drugs at the work site and
       while on official business, on duty or on call for duty.
       A provision for random drug testing of employees and a written plan to handle employees
       who test positive for illegal drug use whether the usage occurs at work or during off duty
       hours.
       Documentation shall be readily retrievable upon request by the Bureau.

    A financial management policy;

The provider shall establish a system of business management and staffing to assure maintenance
of complete and accurate accounts, books and records in keeping with generally accepted
accounting principles. The provider:

                   Must demonstrate fiscal accountability through regular recording of its
                   finances and an annual external audit or audit review conducted by a certified
                   public accountant in accordance with government auditing principles.
                   Must be capable of reporting fiscal data from July 1 through June 30.
                   Must maintain adequate funding for required staff and services.
                   Must maintain a separate business bank account.




                                      Page 6 of 10                                    Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                 04/01/09
                                 REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                    PAGE(S) 10


   A recipient orientation policy;

Orientation must be conducted for all new recipients and annually thereafter. Information must
be provided to the recipient verbally and in writing.          The recipient must sign an
acknowledgement form that he/she received the information. A copy of the signed
acknowledgement form must be given to the recipient. The orientation information must include
the following:

               A mission statement;
               Array and type of intervention services offered;
               Staff qualifications;
               A statement of afterhours access to services;
               Recipients crisis management procedures, including de-escalation;
               Complaint resolution procedures, including DHH as the final point of resolution;
               Discharge planning procedure;
               Information as required by the Bureau including but not limited to a consumer
               handbook;
               Emergency preparedness plan;
               Seclusion and restraint policy; and
               Recipient‘s rights including but not limited to:
                     Freedom to choose his/her provider,
                     The right to ask for a different provider,
                     The right to request changes to their ISRP, crisis plan, and discharge plan,
                     The right to confidentiality,
                     The right to review their record,
                     The right to complain about their services without fear of reprisal, such as
                     discontinuance of services, and
                     The right to be free from being restrained or secluded, unless necessary to
                     protect him/herself or others from harm.

NOTE: Recipients have these rights regardless of their age, race, sex, religion, culture, lifestyle,
ability to communicate, and disability.




                                       Page 7 of 10                                   Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                            04/01/09
                                 REPLACED:                                          06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                PAGE(S) 10



Quality Management Policy

The provider shall have systems and procedures for the ongoing monitoring of the quality,
appropriateness and utilization of services delivered. Data collected must be reliable, valid,
complete and accurate. Provider staff performing the quality management (QM) function should
be knowledgeable regarding QM procedures.

Findings should be used to make programmatic changes, to identify training needs, to improve
the quality of services and in financial and resource planning. Input from recipients and other
stakeholders, obtained through public hearings, representation on advisory committees, or small
focus groups, must be an integral part of the process. Documentation must include:

                     Staff member who performed the QM function,
                     Written statement noting all deficiencies found,
                     Evidence that action was taken as a result of the findings to prevent
                     reoccurrence of the deficiency,
                     Documentation of who performed the follow up action,
                     A review of a representative sample of recipient records that include
                     MHRSIS reports and service logs to assure compliance with the ISRP,
                     A comprehensive recipient satisfaction survey conducted annually, and
                     Outcome data regarding the effectiveness of the program.


Program Philosophy

The provider must describe the program philosophy and all relevant program standards that
include the following:

          Using input from the recipient and from others such as family members, caregivers
          and advocates.
          Sharing information with the recipient and with parents/guardians in the case of
          children and youth.
          Supporting recovery of the recipient.
          Enhancing the quality of life for the recipient.
          Reducing symptoms.
          Supporting the integration of the recipient into the community.
          Developing an ISRP for each recipient with goals based on an assessment.




                                     Page 8 of 10                                 Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                 04/01/09
                                 REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                    PAGE(S) 10




Provider Operations

The provider must establish regular business office hours for all certified and enrolled office
locations. These locations must be fully operational at least eight (8) hours a day, five (5) days a
week between 7 a.m. and 7 p.m.

NOTE: This requirement does not apply to off-site service delivery locations.

Each office shall contain office equipment and technology that meets requirements established
by the Bureau (Appendix A) and furnishing requisite to providing services including but not
limited to:

                                         Computers
                                         Facsimile machines
                                         Telephones
                                         Lockable file cabinets

Offices shall be located in areas separate and apart from areas of residential occupancy and be
clearly identifiable as a separate office. The environment must be appropriate to the care and
treatment of the recipients and ensure confidentiality and personal safety.

An office location is fully operational when the provider:

                       Is certified to offer Mental Health Rehabilitation services and is enrolled
                       in Medicaid.
                       Has at least five active recipients at the time of any recertification or
                       monitoring review, other than the initial application review. To be
                       considered active, a recipient must be authorized for services.
                       Is capable of accepting referrals at any time during regular business hours.
                       Retains adequate staff to assess process and manage the needs of current
                       recipients.
                       Has the required designated staff on-site (at each location) during business
                       hours.
                       Is immediately available to its recipients and the Bureau by
                       telecommunications twenty-four (24) hours per day. Note: Recipients
                       should have an agency contact number for use in emergencies and should
                       not automatically be directed by voice mail or staff to call 911 or go to an
                       emergency room.
                       Maintains insurance coverage.
                                       Page 9 of 10                                   Section 31.4
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                04/01/09
                                 REPLACED:                                              06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.4: PROGRAM OPERATIONS                                                   PAGE(S) 10



Services may be delivered in off-site service delivery locations that are:

                       Publicly available and commonly used by members of the community
                       other than the provider (e.g., libraries, community centers, Young Men‘s
                       Christian Association (YMCA), church meeting rooms, etc.);
                       Used solely for the provision of allowable off-site service delivery;
                       Directly related to the recipient‘s usual environment (e.g., home, place of
                       work, school); or
                       Utilized in a non-routine manner (e.g., hospital emergency rooms or any
                       other location in which a crisis intervention service is provided during the
                       course of the crisis).
NOTE: Providers who utilize off-site service delivery locations solely for the provision of
allowable services must notify the Medicaid Behavioral Health Section regarding this reportable
change as outlined in the Provider Certification and Recertification section of this manual
(section 31.3). The Medicaid Behavioral Health Section may conduct a site review. Off-site
service delivery locations may not house records, maintain staff or be used to conduct regular
business.

Every location where services are provided shall be established with the intent to promote
growth and development, recipient confidentiality and safety. Service may not be provided in
the home (s) of the provider‘s owner, employees or agents. Group counseling and psychosocial
skills training (adult and children/youth) services may not be provided in a recipient‘s home or
place of residence. Services may not be provided in the professional practitioner‘s private office.
The provider accepts full responsibility to ensure that its office locations meet all applicable
federal, state and local licensing requirements. The transferring of license and certifications to
new locations is strictly prohibited. It is also the responsibility of the provider to notify the
Bureau immediately of any office relocation or change of address and to obtain a new
certification and license (if applicable).
Each provider must develop and implement an emergency preparedness plan that includes:
            The measures that will be taken to ensure the safety and security of employees and
            recipients;
            Provisions to protect business records, including employee and recipient records;
            and
            A means of communication with the Bureau to report status of the provider post-
            disaster.

NOTE: If the provider must close its offices due to the disaster, the provider may not resume
provision of reimbursable services until authorized to do so by the Bureau.


                                       Page 10 of 10                                  Section 31.4
LOUISIANA MEDICAID PROGRAM          ISSUED:                                            04/01/09
                                    REPLACED:                                          06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                               PAGE(S) 14


                              STAFFING AND TRAINING

The Bureau has established staffing requirements to maintain an adequate level of effective,
efficient, and professional services. The provider must ensure that the staff members possess the
minimum requisite skills, qualifications, training, supervision, and coverage in accordance with
the requirements described in this section.


Staffing Requirement

Appropriate staffing must be available to adequately implement the ISRP for each recipient.
Loss of required staff is a reportable change to the Bureau. In the event a required staff member,
such as a psychiatrist, leaves employment, the provider has up to thirty (30) days to hire a
replacement. All staff lists must be maintained and up to date in MHRSIS.


Personnel Records

A personnel records creation and retention policy shall be developed, implemented and
maintained by the provider. The provider shall maintain documentation and verification of all
relevant information necessary to assess qualifications for all staff, volunteers and consultants.
All required licenses as well as professional, educational, work experience and dates of
employment must be verified. All verifications must be documented in the employee‘s or
agent‘s personnel record prior to the individual providing billable Medicaid services.

The personnel records shall include the following documentation:

   Current resume or employment application, which must include documentation of previous
   employment,
   Employee credentials including current professional license, diploma and official transcripts,
   Valid Louisiana (LA) driver‘s license and current automobile insurance;
   Employee training and orientation documentation as required by the Bureau,
   Completed ACE application and approval by the Bureau,
   CPRP application, approval letter from USPRA and all other related documents, as
   applicable,
   Three (3) references,
   References must be obtained prior to employment, for any employee who will be directly
   providing services. At least two (2) of the references must be professional and/or work
   related. Professional/work related references must be explicit with regard to previous work
   experience and performance. The reference documentation must include the date, address
   and telephone number of the individual who is providing the reference.

                                        Page 1 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                              04/01/09
                                    REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                                 PAGE(S) 14



   Annual performance evaluations,
   Employment experience and dates of employment
   Employment verification shall include written documentation from a previous employer or a
   signed statement verifying that they spoke with the previous employer through verbal
   contact. The statement should assure and document, the applicant‘s experience, and include
   the name, address and current telephone numbers of the former employer or supervisor. If
   the past employer is no longer in business, and employment cannot be verified by personnel,
   that job experience may not be included toward required experience. The month and year of
   past employment must be documented.

   Experience must be in a paid, forty (40) hours per week position. Experience obtained while
   working in a position for which the individual is not qualified may not be counted as
   experience. If experience is in a part-time position, the staff person must be able to verify the
   amount of time worked equals the required time period for full time employment. College
   work/study or internship related to completion of a degree cannot be counted as work
   experience.

   Education Verification
   Educational documents, including diplomas, degrees and certified transcripts shall be
   maintained in the records. All college degrees must be from a nationally accredited
   institution of higher education as defined in Section 102(b) of the Higher Education Act of
   1965, as amended.

Confidential Information

The following shall be maintained in a separate confidential file available for review when
requested by the Bureau or other legitimate governmental entities:

          Drug testing results,
          Criminal background check, and
          TB test results.


Staff Qualifications

Services shall be provided by individuals who meet the following education and experience
requirements:

NOTE: All documents must be maintained and readily retrieved for review by the Bureau.



                                        Page 2 of 14                                  Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                            04/01/09
                                    REPLACED:                                          06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                               PAGE(S) 14

Licensed Mental Health Professional (LMHP)

An LMHP must be a graduate of an accredited institution with a degree in a mental health-
related field and is licensed to practice in the state of Louisiana by the applicable professional
board of examiners. An LMHP provides professional mental health services within the scope
and ethical boundaries allowed by the professional license.

The following professionals are considered LMHPs:

           Psychiatrist
           Psychologist
           An advanced practice registered nurse (APRN), who is a clinical nurse specialist in
           psychiatry or a Nurse Practitioner (NP) certified in psychiatry or mental health
           nursing
           Licensed Clinical Social Worker
           Licensed Professional Counselor

Psychiatrist

Providers shall have a contract with a psychiatrist(s) to provide consultation and/or services at
the MHR office, an off-site service delivery location, or in a recipient‘s natural environment
(home or school) as medically necessary. The psychiatrist must be a licensed medical doctor
(M.D. or D.O.) who is board-certified or board-eligible, authorized to practice psychiatry in
Louisiana, and enrolled to participate in the Louisiana Medicaid Program.

A board eligible psychiatrist may provide psychiatric services to MHR recipients if he/she:

           Holds an unrestricted license to practice medicine in Louisiana and unrestricted Drug
              Enforcement Administration (DEA) and state and federal controlled substance
              licenses. If licenses are held in more than one state or jurisdiction, all licenses
              held by the physician must be documented in the employment record and be
              unrestricted.

           Has satisfactorily completed a specialized psychiatric residency training program
           accredited by the Accreditation Council for Graduate Medical Education (ACGME),
           as evidenced by a copy of the certificate of training or a letter of verification of
           training from the training director which includes the exact dates of training and
           verification that all ACGME requirements have been satisfactorily met. If training
           was completed in child/youth psychiatry, the training director of the child/youth
           psychiatry program must document such training.




                                        Page 3 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                           04/01/09
                                    REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                              PAGE(S) 14

               If training was completed in a psychiatric residency program not accredited by the
               ACGME, the physician must demonstrate that he/she meets the most current
               requirements as set forth in the American Board of Psychiatry and Neurology‘s
               Board Policies, Rules and Regulations regarding information for Applicants for
               Initial Certification in Psychiatry.

Psychologist

An individual licensed as a practicing psychologist under the provisions of R.S. 37:2351– 2367.

Advanced Practice Registered Nurse (as LMHP)

A nurse as an LMHP must:
Be an Advanced Practice Registered Nurse (APRN)/Clinical Nurse Specialist (CNS) or Nurse
Practitioner (NP), certified by a nationally recognized certifying body such as the American
Nurses Credentialing Center in psychiatry and licensed by the Louisiana State Board of Nursing.

An APRN must be enrolled to participate in the Louisiana Medicaid Program and must operate
under an approved collaborative practice agreement with a board-certified or board eligible
psychiatrist. The Louisiana Board of Nursing must approve the practice agreement prior to
delivering services.

For information regarding an APRN Collaborative Practice Agreement, see ―Forms‖ at the
website www.lsbn.state.la.us.

Licensed Clinical Social Worker

An individual who has a master‘s degree in social work from an accredited school of social work
and is a licensed clinical social worker under the provisions of R.S. 37:2701 – 2723.

Licensed Professional Counselor

An individual, who has a master‘s degree in a mental health-related field, Licensed under the
provisions of R.S. 37:1101 – 1115 and has two (2) years post-masters experience in mental
health.




                                       Page 4 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                              04/01/09
                                    REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                                 PAGE(S) 14

Approved Clinical Evaluator (ACE)

An LMHP who conducts an initial assessment or reassessment must meet all Approved Clinical
Evaluator (ACE) standards including attending training conducted by the Bureau. Initial ACE
approval may be denied if the LMHP does not demonstrate competency in completing
assessments based on factors including, but not limited to, participation in training activities and
rating sample cases. ACE approval may be suspended or revoked if assessments do not
accurately reflect the needs of recipients, or if an ACE does not attend additional training as
requested by the Bureau.
ACE staff must complete and return all required documentation including a current ACE
application to ensure that the Bureau has current information regarding his/her employment.

Mental Health Professional (MHP)
A Mental Health Professional (MHP) must meet the following educational criteria.

               A Master of Social Work degree;
                                                      or
               A Master of Arts, Science or Education degree in a mental health related field
               (refer to the Glossary for a definition of a mental health related field);
                                                     and
               A minimum of fifteen (15) hours of graduate level course work and/or practicum
               experience in applied intervention strategies/methods designed to address
               behavioral, emotional and mental disorders as a part of, or in addition to the
               master‘s degree.
NOTE: The MHP must work under the supervision of an LMHP.

Mental Health Specialist (MHS)

A Mental Health Specialist must meet the following educational criteria.

               A Bachelor‘s degree in a mental health related field;
                                              or
               A Bachelor‘s degree, enrolled in college and pursuing a graduate degree in a
               mental health related field and has completed at least two (2) courses identified in
               a mental health related field;
                                              or
               A high school diploma or a GED, and at least four (4) years experience providing
               direct services in a mental health, physical health, social services, education or
               correctional setting.
NOTE: The MHS must work under the supervision of an LMHP.


                                         Page 5 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                           04/01/09
                                    REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                              PAGE(S) 14

Registered Nurse (RN)

A registered nurse (RN) licensed by the Louisiana State Board of Nursing or a licensed practical
nurse licensed by the Louisiana Board of Practical Nurse Examiners may provide designated
components of medication management services if he/she meets the following requirements:

A registered nurse must have:

              A Bachelor‘s degree in nursing and one (1) year of supervised experience as a
              psychiatric nurse which must have occurred no more than five (5) years from the
              date of employment with the provider;
                                               or
              An Associate degree or diploma in nursing and two (2) years of supervised
              experience as a psychiatric nurse which must have occurred no more than five (5)
              years from the date of employment with the provider;
                                              and
              Six (6) Continued Education Unit (CEUs) regarding the use of psychotropic
              medications, including atypicals, prior to providing direct services to recipients.

NOTE: Supervised experience is experience in mental health services delivery acquired while
working under the formal supervision of an LMHP.

Licensed Practical Nurse (LPN)

A licensed practical nurse licensed by the Louisiana Board of Practical Nurse Examiners may
perform medication administration if he/she has:

     One year of experience as a psychiatric nurse which must have occurred no more than five
     (5) years from the date of employment with the MHR provider;
                                          and
     Six (6) CEUs regarding the use of psychotropic medications, including atypicals, prior to
     providing direct services to recipients.

NOTE: Registered nurses and licensed practical nurses providing services shall have
documented evidence of five (5) CEUs annually, which are specifically related to behavioral
health and medication management issues.




                                       Page 6 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                          04/01/09
                                    REPLACED:                                        06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                             PAGE(S) 14

Staff Responsibilities

The LMHP is responsible for all clinical services and supervision of all non-licensed staff. The
LMHP must:

         Direct the collection of data for the initial assessment and reassessments.
         Conduct, at a minimum, one face-to-face interview with the recipient and their
         family/significant others during an initial assessment and reassessments.
         Provide DSM-IV (or its successor) diagnoses, Axes I-V if qualified to do so.
         Develop, sign and date the initial assessment and reassessment.
         Develop, sign and date the initial ISRP.
         Develop or review, sign and date ISRP updates.
         Develop, sign, and date Request for Revision form.
         Administer and score LOCUS/CALOCUS, if an ACE, as part of the initial assessment,
         reassessments, with each Request for Revisions, or as required by the Bureau.
         Act as team leader of the service planning team.
         Provide crisis intervention services as needed.
         Notify the provider‘s staff psychiatrist of any significant change in a recipient‘s
         physical or mental status.

The LMHP may:

         Provide all core services except medication management, unless qualified to do so.
         Act as team leader for a PFII team.
         Act as program director for a PSR program.
         Provide staff training as needed.
         Perform the quality management function as needed.
         Supervise non-LMHP staff.
         Review and sign the Electronic Case Data Inquiry (e-CDI) screen print. If no data is
         available, the screen print must also be signed.

A psychiatrist must:

           Have a face-to-face interview with the recipient at initial assessment.
           Review and sign the Medical History Questionnaire section of the initial assessment
           during a face-to-face contact.
           Review and sign the ISRP at initial assessment and reassessment.
           Review and sign the Electronic Case Data Inquiry (e-CDI) screen print. If no data is
           available, the screen print must also be signed.




                                       Page 7 of 14                                Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                              04/01/09
                                    REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                                 PAGE(S) 14

           Be available to participate in crisis intervention emergencies.
           Provide face-to-face, medically necessary, services on site for each recipient who has
           selected the provider‘s staff psychiatrist. If consultation or a service with a recipient
           is not required on a monthly basis, the psychiatrist must provide documentation of the
           rationale for a reduction in the frequency of services.

The psychiatrist may

           Provide DSM-IV (or its successor) diagnoses, Axes I-V.
           Provide medication management.
           Participate in team meetings.

An advanced practice registered nurse (APRN) or a nurse practitioner may provide DSM-IV (or
its successor) diagnoses, Axes I-V and medication management.

NOTE: The requirements listed above must be provided by an MHR or non-MHR Psychiatrist.
If a recipient chooses a non-MHR psychiatrist, the provider is required to ensure all requirements
are met.

An MHP may provide the following services:

                  Community support,
                  Initial assessment and reassessments (billed by the LMHP only),
                  Individual and/or group counseling,
                  Group Psychosocial Skills Training (youth and adults),
                  Parent Family Intervention (Counseling),
                  Parent Family Intervention (Intensive), and/or
                  Participate in quality management and staff training activities.

An MHS may provide the following services:

                  Community support,
                  Initial assessment and reassessments (billed by the LMHP only),
                  Group psychosocial skills (youth and adults),
                  Parent Family Intervention (Intensive), and/or
                  Participate in quality management and staff training activities.

A registered nurse may provide aspects of Medication Management within the scope of his/her
practice.

A licensed practical nurse may provide medication administration.


                                        Page 8 of 14                                  Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                          04/01/09
                                    REPLACED:                                        06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                             PAGE(S) 14

Backup Staff

In the event a staff member is not available, back up staff must meet all staff qualifications,
training, and supervision requirements outlined in the manual. Critical clinical information,
including the comprehensive crisis plan, the current assessment, and the current ISRP, must be
available to the back-up staff.

Supervision

Every unlicensed employee providing direct clinical services shall receive continuing direct and
documented clinical supervision from a licensed mental health professional. Supervision shall
be carried out by the LMHP who is directly responsible for the recipient. Peer supervision may
not be used.

Employees must have an individualized supervisory plan completed within the first month of
employment and updated annually thereafter. Supervisory sessions must include a record of the
date, time, length of session, type of supervision and a summary of observation and
recommendations concerning job performance.

Supervision of staff shall include direct clinical review, assessment and feedback regarding the
delivery of services, and teaching and monitoring of the application of recovery/resiliency and
Child and Adolescent Service System Program (CASSP) principles and practices. Supervision
must be provided in a culturally sensitive manner that represents the cultural needs and
characteristics of the staff and the service area. Supervision must be available by telephone
whenever the employees are delivering services or are on call. A roster specifying the on-call
supervision schedule must be provided to all employees.

The following supervisory methods may be used:

               A face-to-face session with individual employees to review cases, assess
               performance and provide feedback.
               A session in which the supervisor observes and assesses an employee during the
               delivery of services to recipient(s), followed by feedback regarding the
               employee's performance.
               Face-to-face sessions with a group of six (6) or fewer employees to problem-
               solve, provide feedback, and generate peer supervision and support.
               Supervisory reviews of recipient records for evaluation and feedback on employee
               job performance.
               Annual performance evaluations.
               Review of recipient reports and staff meetings that assess the recipient‘s
               performance and provide the staff direction regarding individual cases.



                                       Page 9 of 14                                Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                              04/01/09
                                    REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                                 PAGE(S) 14

Initial Supervision

Non-LMHP staff shall receive face-to-face supervision and observation for a minimum of two
(2) hours each week for the first three (3) months of employment while they are providing
eligible services. This policy shall not supersede any professional practices act.

Ongoing Supervision

While providing services, non-LMHP staff shall receive face-to-face supervision and observation
for a minimum of one (1) hour per month after completing the initial supervision period. The
policy shall not supersede any professional practices act.

NOTE: A new employee does not need to complete the initial supervision if there is
documentation indicating that the required initial supervision was completed within the past
twelve (12) months. This applies only to employees who are rehired by the same provider or
who transfer from another MHR provider.

Ongoing supervision and feedback from the licensed person actively directing the case shall
occur on a routine basis to ensure:

               Provision of appropriate services specific to the ISRP;
               Provision of assistance to recipients in order to meet individual goals;
               Incorporation of recovery/resiliency and rehabilitation in all aspects of service
               delivery;
               Effective treatment;
               Assessment of progress;
               Proper reporting of significant issues including possible abuse, neglect extortion,
               exploitation, health and safety issues and crises


Orientation and Training

Orientation and training shall be provided to new staff member, subcontractor, volunteer, or
intern.

      The provider shall develop, implement and maintain an orientation and ongoing training
      policy that conforms to the standards in the provider manual. All employees, volunteers,
      and students must receive orientation and training prior to providing services.

Orientation training should be comprised of no less than five (5) face-to-face hours of training.




                                        Page 10 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                            04/01/09
                                    REPLACED:                                          06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                               PAGE(S) 14


      All orientation and training shall be documented in the employee‘s personnel record. The
      documentation shall include the date, title, class time (s), name and credentials of all
      trainers, and a dated, original signature of the trainee.

      Initial and ongoing training shall occur on a routine basis to ensure that the staff
      demonstrate competency in the areas identified in the MHR provider manual. Staff
      competency is evidenced by the staff person‘s ability to describe and apply the information
      obtained in the orientation and training. Ongoing training shall also be offered in response
      to service delivery issues identified through quality management activities.

      A new employee does not need to complete orientation training if there is documentation
      indicating that training was completed within the past twelve (12) months. This applies to
      employees who are rehired or who transfer from another provider.

      The backup staff must meet the orientation and training requirements outlined below who
      are providing backup support, with the exception of psychiatrist. The Backup psychiatrist
      must complete the orientation listed below within forty (40) hours of direct services.

      The medical staff, including the psychiatrist, APRN/CNS, NP, RN and LPN, may
      substitute review of a Bureau-approved training packet in lieu of the required sixteen (16)
      hours of orientation. The RN and LPN are only allowed to make the substitution for the
      sixteen (16) hours of orientation if medication management is the only service they will
      provide.

Orientation is not billable.




                                        Page 11 of 14                                Section 31.5
       LOUISIANA MEDICAID PROGRAM          ISSUED:                                               04/01/09
                                           REPLACED:                                             06/01/05
       CHAPTER 31: MENTAL HEALTH REHABILITATION
       SECTION 31.5: STAFFING AND TRAINING                                               PAGE(S) 14

                                     Orientation and Training Hours

Type                                                    Must be Completed                          Duration

Orientation – any staff member, subcontractor,          Prior to providing service for which       16 hours
volunteer or intern                                     billing will be submitted


On-the-job training (Non-LMHP staff only)               Prior to providing service for which       16 hours
                                                        billing will be submitted


Rating the LOCUS and CALOCUS (ACE staff only) Prior to conducting an initial or                    6 hours
                                              reassessment

Other required training (any staff member,              Within the first 60 days of                Varies
subcontractor, volunteer, or intern)                    employment


Job specific training                                   Annually                                   See details
                                                                                                   below


       Orientation On-Site Instructions

       The following training must be completed prior to providing services for which billing will be
       submitted. Sixteen (16) hours of on-site instruction includes all of the following content areas:

                        Confidentiality,
                        Protection of rights and reporting of violations,
                        Abuse and neglect policies and procedures,
                        Emergency and safety procedures,
                        Infection control procedures,
                        Agency policies and procedures,
                        Ethics, including advertising and solicitation,
                        Basic information about mental illness,
                        Developing and implementing behavioral interventions,
                        Skills training (specific teaching methods and methods to track consumer
                        progress),
                        Linking and coordinating natural and community supports,
                        Crisis intervention,


                                                 Page 12 of 14                                 Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                           04/01/09
                                    REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                               PAGE(S) 14

              Suicide and homicide precaution procedures,
              Developing effective service plans including goals using ―SMART‖ (Specific,
              Measurable, Action-Oriented, Realistic, and Time-Limited),
              Person and family centered services,
              Prevention of workplace violence,
              Expectations regarding professional conduct, and
              Recipient rights.

Recipients and/or family members may be used as instructors or assistants for up to two
(2) hours of training.

On-the-Job Training

Non-LMHP staff must be provided with at least sixteen (16) hours of on-the-job training, which
involves observing and assisting a trained staff member in the delivery of services. Initial
supervision as described earlier in this Section begins the first week after completed on-the-job
training.

The following training must be completed prior to an LMHP conducting and billing for an initial
assessment or reassessment.

LOCUS and CALOCUS Training

This training must be completed within the first sixty (60) days of employment.

Other Required Training

       Prior to handling or managing crisis calls unlicensed person employed by the provider
       shall have at least six (6) hours of documented training in Crisis Prevention Intervention
       (CPI) using a recognized training curriculum. The trainer must have documented
       experience in teaching and utilizing CPI intervention techniques consistent with state and
       federal laws. This training must be updated annually.
       Cultural competency training designed to achieve respect for cultural differences and
       cultural proficiencies related to the populations served by the provider.
       First aid, cardiopulmonary resuscitation (CPR) and seizure assessment.
       Implementation of a behavior management plan.

NOTE: Psychiatrist, APRN/CNS, NP, and RN, and LPN are exempt from first aid and
      seizure assessment training.
NOTE: Supervision as previously defined in this provider manual is not considered
      training.


                                       Page 13 of 14                                Section 31.5
LOUISIANA MEDICAID PROGRAM          ISSUED:                                              04/01/09
                                    REPLACED:                                            06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.5: STAFFING AND TRAINING                                                 PAGE(S) 14

Job Specific Training

Employees who provide services to the targeted groups shall have training, experience working
with these groups, and receive supervision from a staff member with specialized training and
experience. All staff providing direct services for a PSR program must have documented
training related to the psychosocial rehabilitation model(s) utilized in the program.

All employees, except the psychiatrist, shall receive annual training specifically related to his or
her job duties. The provider must furnish and/or arrange for competency-based training to
personnel rendering direct services based on needs identified through quality management and
supervision:

Annual Training

LMHP and MHP staff – twenty (20) hours
MHS staff - thirty (30) hours

Online training is an approved method of instruction. The provider must ensure the content is
competency based and meets the needs identified through quality management and supervision.
Training content must be available at the request of the Bureau.

Qualified Trainers

Training shall be provided by persons with documented knowledge of the training topic and of
the seriously mentally ill and/or emotionally/behaviorally disordered populations. Recipients
and family members of persons with serious mental illness or serious emotional behavior
disorder may provide training as is appropriate to their experience and knowledge.

Bureau Training

The provider staff must attend and participate in all trainings and meetings mandated by the
Bureau.




                                         Page 14 of 14                                Section 31.5
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                      08/01/09
                                REPLACED:                                                    04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                             PAGE(S) 6

                                     RECORD KEEPING
Provider records must be maintained in an organized and standardized format at the enrolled office
site. Original records shall not be kept in off-site service delivery locations. The provider must have
adequate space, facilities, and supplies to ensure effective record keeping.


Retention of Records
The provider must retain administrative, personnel and recipient records for five (5) years from
the date of the last payment. However, if the provider is being audited, records must be retained
until the audit is complete, even if the five (5) years is exceeded.
In the event records are destroyed or partially destroyed in a disaster, such as a fire, flood or
hurricane and rendered unreadable and unusable, such records must be properly disposed of in a
manner, which protects recipients‘ confidentiality. A letter of attestation (refer to Appendix B)
must be submitted to:
For USPS mail delivery:                             For hand delivery or delivery via a parcel service:
Medicaid Behavioral Health Section                  Medicaid Behavioral Health Section
P.O. Box 91030                                      Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                          628 North 4th Street
                                                    Baton Rouge, LA 70802
Fax: (225) 342-1972 or (225) 342-1973 or Toll Free at (866) 427-2148

NOTE: Upon agency closure, all provider records must be maintained according to applicable
      laws, regulations and the above record retention requirements. The Bureau must be
      notified of the location of the records.


Destruction of Records
After the required record retention period has expired, records may be destroyed. Confidential
records must be incinerated or shredded to protect sensitive information. Non-paper files, such as
computer files, require a special means of destruction. Disks or drives can be erased and reused, but
care must be taken to ensure all data is removed prior to reuse. Commercially available software
programs can be used to ensure all confidential data is removed.


Confidentiality and Protection of Records
Administrative and recipient records are the property of the provider. Records must be secured
against loss, tampering, destruction or unauthorized use in accordance with Health Insurance
Portability and Accountability Act (HIPAA) regulations.


                                          Page 1 of 6                                     Section 31.6
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                08/01/09
                                REPLACED:                                              04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                       PAGE(S) 6
The provider must safeguard the confidentiality of any information, which may identify the
recipients or their families. The information may be released only under the following
conditions:

              By a court order,
              By the recipient's written, informed consent for release of information,
              If the recipient has been declared legally incompetent, his/her legal representative
              must provide written consent, or
              If the recipient is a minor, the parent or legal guardian must provide written
              consent, or

Upon request, a provider must make available information in the recipient records to the
recipient, legally responsible guardian, or other service providers including another MHR
provider in the case of a recipient transfer. If, in the professional judgment of the provider,
information contained in the record would be harmful to the recipient, that information may be
withheld from him/her except under court order.

A provider may use material from recipient records for educational purposes if names are deleted
and other identifying information is removed. For research purposes, providers must comply
with the Bureau‘s research policy (refer to Appendix C), which is posted on the MHR website,
www.mhrsla.org.
NOTE: Under no circumstances should providers allow staff to remove recipient
records from the provider‘s site.

Review by State and Federal Agencies
Providers must make all administrative, personnel and recipient records available to the Bureau
and appropriate state and federal personnel upon request. Failure to allow access to records in a
timely manner may result in a sanction.

Administrative and Personnel Records

The provider's administrative files must have critical program information including but not
limited to documentation of Medicaid enrollment, insurance policies, minutes of formal
meetings, bylaws of the governing body, if applicable, training and supervision documentation,
and required policies and procedures as detailed in Section 31.5.
Personnel records shall be maintained for all staff, subcontractors, volunteers and interns. The
record must contain all documents detailed in Section 31.5 Staffing and Training-Personnel
Records). An employee must have reasonable access to his/her personnel file and must be
allowed to include any written statement he/she wishes in the file.



                                       Page 2 of 6                                   Section 31.6
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                 08/01/09
                                REPLACED:                                               04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                        PAGE(S) 6
A provider must not release a personnel file without the employee's written permission except
according to state law.


Recipient Records

Records must be maintained in chronological order. Documentation shall be sufficient to verify
that services conform to the Bureau policy as stated below and that the reimbursement amount is
correct.

The organization of individual records and location of documents must be uniform. Records
must be appropriately thinned so that current material can be easily located. Records must
contain at least six (6) months of current pertinent information relating to services provided.
Records older than six (6) months must be kept on-site and be available for review upon the
request of the Bureau.

All entries and forms completed by staff in recipient records must be:

               In ink, in a color other than black,
               Legible,
               Fully dated,
               Legibly signed, and
               Include the functional title of the individual making the entry.

Any error in a recipient's record must be corrected using the legal method, which is to draw a
line through the incorrect information, write "error" by it and initial the correction. Correction
fluid must never be used in a recipient's records. If information is typed, signatures must be
in ink, in a color other than black.

Components of Recipient Records

The recipient's record must consist of the active recipient record and stored files or folders. The
active record must contain the following current information unless a recipient refuses
disclosure, which may include race, ethnic origin, sex, or marital status.

Identifying information recorded on a standardized form including the following:

                   Name,
                   Home address,
                   Home telephone number,
                   Date of birth,
                   Sex,
                   Race or ethnic origin,

                                        Page 3 of 6                                   Section 31.6
LOUISIANA MEDICAID PROGRAM      ISSUED:                                        08/01/09
                                REPLACED:                                      04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                PAGE(S) 6


          Living arrangements,
          Closest living relative/guardian,
          Education,
          Marital status,
          Name, address, and telephone number of employer or school,
          Date of initial contact,
          Court and/or legal status, including relevant legal documents,
          Names, addresses, and telephone numbers of other involved with the
          recipient's ISRP,
          Date this information was gathered,
          Required signatures on all forms, and
          Signed release of information form.

       Documentation verifying that the recipient meets medical necessity criteria
       including copies of required professional evaluations, past treatment records,
       LOCUS/CALOUS rating, the MHR screening form, the MHR initial and
       reassessment reports, and other reports and information concerning the recipient‘s
       medical, social, familial, cultural, developmental, legal, educational, vocational,
       psychiatric and economic status.

       Electronic clinical data inquiry printout.

       Medicaid eligibility information for Medicaid recipients.

       A copy of the Freedom of Choice form, confidentiality information, complaint
       procedures, etc. signed by the recipient.

       A completed and signed ISRP including the crisis plan and discharge plan.

       Reason for case closure and any agreements with the recipient at closure.

       Service logs.

       Copies of all pertinent correspondence.

       If the provider is aware that a recipient has been interdicted, a statement to this
       effect must be noted and the court appointed guardian named.

       A description of any current treatment or medication necessary for the treatment
       of any serious or life threatening medical condition or known allergies. This may
       include documentation from the treating physician.



                                 Page 4 of 6                                 Section 31.6
LOUISIANA MEDICAID PROGRAM      ISSUED:                                               08/01/09
                                REPLACED:                                             04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                       PAGE(S) 6


Service Logs

Service logs document the allowable services billed and must reflect the services delivered. To
obtain a copy of the service log, refer to Appendix D. They will be reviewed during
recertification, monitoring, and when deemed necessary by the Bureau. Record entries must
correspond with the services provided including billable services entered into the statewide data
system as well as non-billable services.

Non-billable services, such as team planning or services provided during a lapse in
authorizations must be documented on a service log with the statement ―Non-billable Service‖
written at the top of the log. Federal and state requirements for documenting claims require that
the following information must be entered on the service log:

               Service log number,
               Name of recipient,
               Name of provider and employee providing the service,
               Date of service contact,
               Begin and end time for service rendered,
               Indication if a crisis occurred during the contact,
               Place of service contact,
               Type of contact,
               Service provided,
               Service Participants, and
               Narrative describing the service.

Service logs must include specific documentation instead of using general terms such as
"assisted recipient to" and "supported recipient" do not constitute adequate documentation.
When more than one service is provided to a recipient during a contact, a service log must be
completed for each service. For each log entry, the goal, objective, and intervention as
documented in the ISRP must be paraphrased. The use of goal, objective, and intervention
numbering is not acceptable. For example, ―Goal 1, Objective 1, Intervention 1‖ does not
constitute acceptable documentation. All of the following documentation components must be
included for each log entry:

         Goals, objectives, and interventions documented in the recipient‘s current ISRP. If
         crisis services are provided, the ISRP must be updated to reflect the needed services.
         Services are appropriate in terms of frequency and intensity.
         Services are clinically appropriate to the needs of the recipient.




                                       Page 5 of 6                                  Section 31.6
LOUISIANA MEDICAID PROGRAM      ISSUED:                                                  08/01/09
                                REPLACED:                                                04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.6: RECORD KEEPING                                                         PAGE(S) 6

          Specific intervention (s) and training material used during the contact.
          Recipient‘s response to interventions using observable/behaviors terms.
          Recipient‘s progress with accomplishing the targeted goal or objective.
          A plan for the next recipient contact to ensure continuity of services.
          Specific location when services are provided in the community.

Only the staff member providing the services may develop, sign, and make any necessary
corrections to the service log. Service logs must be completed at or near the time of service to
ensure accuracy.

Services logs must be reviewed and signed by the supervisor on a regular basis to ensure that all
activities are appropriate, relative to the service type, location, service participant and duration
and that documentation is sufficient to indicate progress towards achievement of treatment goals.
Supervision is not billable.




                                         Page 6 of 6                                  Section 31.6
LOUISIANA MEDICAID PROGRAM       ISSUED:                                               04/01/09
                                 REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.7: PROGRAM MONITORING                                                    PAGE(S) 2


                              PROGRAM MONITORING
The Bureau will monitor providers to ensure services comply with program standards. It is the
provider‘s responsibility to be knowledgeable regarding the policies and procedures governing
the program. Non-compliance may result in the recoupment of Medicaid payments,
administrative sanctions and/or a referral to the appropriate state and/or federal authorities for
further investigation, which may result in additional punitive action.
The Bureau may conduct a monitoring review for reasons including but not limited to ensuring
compliance with program requirements, reviewing billing practices and investigating complaints
and grievances.


Monitoring
A monitoring review may include a review of the following:
       Recipient records,
       Personnel records,
       Administrative records,
       Provider profile data,
       MHRSIS/Utopia data reports,
       Accreditation reports,
       Staff and recipient interviews, and
       Any other requested data or files.

Interviews
Monitoring interviews may include interviews with the following:

    A representative sample of the recipients,
    An adult recipient‘s family and friends, if the recipient approves,
    A child‘s family, friends, teacher and other school personnel, with the approval of the parent
    or guardian, and/or
    Current or former staff

Monitoring Results

Upon completion of a monitoring review, the Bureau staff may conduct an exit interview to
discuss the findings. A written report summarizing the findings will be sent to the provider,
stating whether a plan of correction is required.



                                         Page 1 of 2                                 Section 31.7
LOUISIANA MEDICAID PROGRAM       ISSUED:                                                 04/01/09
                                 REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.7: PROGRAM MONITORING                                                     PAGE(S) 2


Plan of Correction

A plan of correction (POC), if required, must be submitted to the Bureau. If the POC is not
submitted within ten (10) working days, sanctions as described in Section 31.8 and Chapter 6 of
the Medicaid Provider Manual may be applied. The POC must address the correction of each
deficiency cited. If the POC submitted does not meet Bureau standards, it may be returned to the
provider for revision.

All deficiencies must be corrected within sixty (60) days of receipt of the notice. Failure to do so
may result in sanctions. A follow-up review may be conducted by the Bureau to ensure that all
deficiencies have been corrected.




                                          Page 2 of 2                                 Section 31.7
LOUISIANA MEDICAID PROGRAM         ISSUED:                                           08/01/09
                                   REPLACED:                                         04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.8: ADMINISTRATIVE SANCTIONS                                            PAGE(S) 4

                          ADMINISTRATIVE SANCTIONS

Administrative sanctions may be imposed against a provider that does not meet the requirements
as established in laws, rules, regulations or policies. This section explains the administrative
actions and sanctions as they apply to a MHR provider. In addition, sanctions cited in Chapter 6
of the Medicaid Services Provider Manual and the Surveillance and Utilization Systems (SURS)
rule, LAC 50:1 Chapter 41 (Louisiana Register, Volume 29, Number 4) may be imposed.

The following sanctions may be applied to any provider independently, consecutively and/or
collectively.

       The provider‘s staff may be required to complete education and training, including
       training in MHR policy and billing procedures provided by DHH. The provider may also
       be required to obtain other education or training relevant to providing quality MHR
       services, such as psychosocial skills training, individual counseling, etc. which the
       Bureau will not provide.
       Payments for services rendered may be suspended or withheld until program compliance
       is verified.
       The provider may be terminated and all service authorizations canceled. Terminated
       providers, including all of the owners, officers, or directors may not apply for
       certification as an MHR provider for a period of up to five years. The provider must
       assist the recipient in locating other services.
       New requests for service authorization or reauthorizations may be denied until program
       compliance is verified.
       The provider‘s current recipients shall be transferred to another provider if the Bureau
       determines that recipient health and safety are compromised. In the absence of an
       available provider, the recipient may be referred to an alternate treatment source.
       Individuals employed by the provider may be suspended or excluded from providing
       MHR services.

NOTE: Health and safety issues will be resolved on a case-by-case basis by Bureau personnel
making a determination after examining the circumstances surrounding each particular event or
finding. The Bureau is allowed the flexibility to explore fully any circumstances surrounding
each unique situation to ensure that the well-being of the recipient and the integrity of the
Medicaid Program are protected.




                                       Page 1 of 4                                 Section 31.8
LOUISIANA MEDICAID PROGRAM         ISSUED:                                                08/01/09
                                   REPLACED:                                              04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.8: ADMINISTRATIVE SANCTIONS                                                PAGE(S) 4

Grounds for Sanctioning Providers

The following are grounds for sanctioning of an MHR provider:

       Failure to comply with any and all certification, administrative, accreditation, training or
       operational requirements at any time;
       Failure to provide the full range of services specified in the recipient‘s service agreement;
       Failure to uphold recipients‘ rights when violations may or could result in harm or injury;
       Failure to notify proper authorities of all suspected cases of neglect, criminal activity, or
       mental or physical abuse which could potentially cause, or actually causes harm to the
       recipient;
       Failure to maintain adequate qualified staff to provide necessary services;
       Failure to adequately document services billed were actually performed;
       Failure of a MHR provider‘s subcontractors to meet all required standards;
       Failure to fully cooperate with a Bureau survey or investigation including, but not
       limited to failure to allow Bureau staff entry to the provider‘s or subcontractor‘s offices
       or denial of access to any requested records during any survey or investigation;
       Failure to comply with all reporting requirements in a timely manner;
       Failure to provide documentation that verifies compliance with any requirement as set
       forth in this policy;
       Failure to comply with any or all federal and state laws, rules and regulations, the
       provider manual and any other notices or directives issued by the Bureau;
       Failure to protect recipients from harmful actions of a MHR provider‘s employees or
       subcontractors including but not limited to health and safety, coercion, threat,
       intimidation, solicitation or harassment;
       Failure to remain fully operational at all times for any reason other than a natural disaster;
       A substantial pattern of consistent complaints filed against a MHR provider, within a one
       (1) year period;
       A false statement of a material fact knowingly (or with reason to know) made by an
       owner or staff person of the MHR provider in the following areas;
               An application for enrollment;
               Data forms;
               A recipient‘s record;
               Any matter under investigation by the Bureau; or
               Certification/recertification or the accreditation process.




                                        Page 2 of 4                                    Section 31.8
LOUISIANA MEDICAID PROGRAM         ISSUED:                                             08/01/09
                                   REPLACED:                                           04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.8: ADMINISTRATIVE SANCTIONS                                              PAGE(S) 4

       If a provider uses false, fraudulent or misleading advertising;
       Failure to disclose a conviction for a criminal offense by a person who has ownership or
       controlling interest in the provider agency, or by a person who is an agent or managing
       employee of the MHR provider; or
       If the facts determined by the department indicate a failure to provide optimum care in
       accordance with current standards of practice.

Informal Review

Any provider receiving a notice of sanction may be provided an opportunity to request an
informal review. The request for an informal review must be made in accordance with the
instructions in the notice of sanction.

The informal review process is designed to allow the provider to:

       Review the reasons and rationale for the proposed sanction(s);
       Discuss the reasons and findings related to the proposed sanction(s);
       Ask questions and seek clarification; and/or
       Submit additional relevant information.

To arrange an informal review, the request must be made by the provider in writing and within
fifteen (15) calendar days (including Saturdays and Sundays) of receipt of original notice of
sanction. All such written requests must be sent to:

For USPS mail delivery:                           For hand delivery or delivery via a parcel
                                                  service:

Medicaid Behavioral Health Section                Medicaid Behavioral Health Section
P.O. Box 91030                                    Bienville Bldg., 7th Floor
Baton Rouge, LA 70821-9030                        628 North 4th Street
                                                  Baton Rouge, LA 70802

Fax: (225) 342-1972 or (225) 342-1973 or Toll Free at (866) 427-2148

The provider may be represented by an attorney or an authorized representative at the review.
The attorney or authorized representative must file a written notice of representation identifying
himself/herself by name, address, and telephone number at the address given above.

After the informal review is completed, the Bureau shall inform the provider in writing of the
results and conclusions. The provider has the right to seek an administrative appeal of the
sanction within thirty (30) days of the receipt of the results of the informal review.


                                        Page 3 of 4                                  Section 31.8
LOUISIANA MEDICAID PROGRAM         ISSUED:                                             08/01/09
                                   REPLACED:                                           04/01/09
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.8: ADMINISTRATIVE SANCTIONS                                              PAGE(S) 4

Notice and Appeal Procedure

A provider that contests any adverse action taken by the Bureau may appeal such action by
submitting a written request for an appeal to the Department‘s Bureau of Appeals. The request
must be received by the Bureau of Appeals within thirty (30) days of the provider‘s receipt of the
written notification of the Bureau‘s action. The appeal should be sent to the following address:

                      Bureau of Appeals
                      Department of Health and Hospitals
                      P O Box 4183
                      Baton Rouge, LA 70821-4183

Sanctions in the form of a termination based on fraud and abuse or health and safety shall take
effect immediately upon notice by the Bureau.

In cases not involving health and safety or program integrity issues where fraud or abuse is at
issue, a sanctioned provider who has timely filed an appeal shall be allowed to accept new
recipients during the appeals process unless the appeal is delayed beyond ninety (90) days due to
action on the part of the provider. If the appeal is delayed beyond ninety (90) days due to action
on the part of the provider, the provider may be prohibited from taking on new recipients until a
ruling on the appeal has been issued.




                                        Page 4 of 4                                  Section 31.8
LOUISIANA MEDICAID PROGRAM        ISSUED:                                                 04/01/09
                                  REPLACED:                                               06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.9: FINANCIAL REIMBURSEMENT                                                 PAGE(S) 2



                           FINANCIAL REIMBURSEMENT


General Provisions for Reimbursement

A particular service shall be excluded from coverage if it is determined to be the legal liability of
any third party who is or may be liable to pay the expenditure for that service.

Services determined to be duplicate will not be reimbursed. Therefore, providers must not bill
Medicaid for MHR services at the same time they bill another funding source for the same
service. Duplicate claims will be denied and may be considered fraud and referred to the
Program Integrity Section for further action.

When a recipient is admitted to an institution or hospital, the provider may bill for services
provided up to the time of admission. The provider may resume billing for services after the
recipient is discharged from the institution or hospital. No services can be billed while the
recipient is in an inpatient facility.

The creation and transfer of information files and the submission of claims are related but
separate processes. Providers are responsible for submitting claims to the fiscal intermediary
(FI) in a timely manner. Any questions regarding a claim should be addressed to the FI Provider
Relations Unit.


Information Transfer/Billing Schedule

To ensure the timely payment of claims, the procedures outlined below should be followed:

       Enter data on MHRSIS daily.
       Create and send an information file daily before 2:30 p.m. to Statistical Resources, Inc.
       (SRI). If a file is received after 3:00 p.m., it will not be processed until the next business
       day.
       Bill for services at least two (2) working days after submission of information to SRI.

Documentation Requirements

Payment decisions are often made based on information contained in the recipient‘s record. If
these records are not properly documented, incorrect payments may be made and overpayments
will be recouped. In some cases, providers may be investigated for fraudulent billing.


                                          Page 1 of 2                                  Section 31.9
LOUISIANA MEDICAID PROGRAM        ISSUED:                                         04/01/09
                                  REPLACED:                                       06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.9: FINANCIAL REIMBURSEMENT                                         PAGE(S) 2




Proper documentation for MHR services includes:

       Documentation of medical necessity for MHR services.
       The MHR initial assessment and reassessments.
       The ISRP includes specific goals and objectives that are individualized and developed
       using SMART criteria (Specific, Measurable, Attainable, Realistic, and Time Limited).
       Service logs for services provided which are related to the ISRP and deemed medically
       necessary.




                                      Page 2 of 2                              Section 31.9
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              04/01/09
                                  REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                                 PAGE(S) 6



                              ACRONYMS/DEFINITIONS

ACE- Approved Clinical Evaluator

ACGME- Accreditation Council for Graduate Medical Education

ADA-American Disability Act

AG – Attorney General

Affidavit- A written statement of facts made voluntarily and under oath.

APRN - Advanced Practice/Registered Nurse

Bureau/BHSF - Bureau Health Services Financing (or its designee)

Board Eligible - A physician who provides psychiatric services that holds an unrestricted license
to practice medicine in Louisiana. If licenses are held in more than one state or jurisdiction, all
licenses held by the physician must be documented in the employment record and be
unrestricted. In addition, the physician must have satisfactorily completed a specialized
psychiatric residency training program accredited by the Accreditation Council for Graduate
Medical Education (ACGME), as evidenced by a copy of the certificate of training or a letter of
verification of training from the training director, including exact dates of training and
verification that all ACGME requirements have been satisfactorily met. If training was
completed in child and youth psychiatry, the training director of the child and youth psychiatry
program must document the child and youth psychiatry training. All documents must be
maintained and readily retrieved for review by the Bureau or its designee.

CALOCUS – Children/Adolescent Level of Care Utilization Scale

CARF - Commission on Accreditation of Rehabilitation Facilities

CASSP- Child and Adolescent Service System Program

CBT- Cognitive-Behavioral Therapy

CEU - Continuing Education Unit

CHOW- Changes in Ownership

CMHC-Community Mental Health Clinic

                                         Page 1 of 6                                Section 31.10
LOUISIANA MEDICAID PROGRAM         ISSUED:                                          04/01/09
                                  REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                             PAGE(S) 6


CMS – Center for Medicare/Medicaid Services

CNS - Clinical Nurse Specialist

COA - Council on Accreditation

Core Mental Health Disciplines—Academic training programs in psychiatry, psychology,
counseling, social work and psychiatric nursing.

CPRP – Certified Psychosocial Rehabilitation Practitioner as designated by the Commission for
Psychiatric Rehabilitation Certification through the United States Psychiatric Rehabilitation
Services Association (USPRA)

CS – Community Support

CSW – Community Support Worker

Department/DHH—Department of Health and Hospitals

DSS – Department of Social Services

e-CDI- Electronic Clinical Data Inquiry

Evidence Based- A clinical intervention, which has been consistently shown in several research
studies to assist recipients in achieving their desired goals of health and wellness.

FBI – Federal Bureau of Investigation

FI – Fiscal Intermediary

FINS- Family In Need of Supervision

Governing Body— The organizers, incorporators, shareholders and board of directors of a MHR
provider; and the principal licensed and professional employees who manage, oversee and
administer the day-to-day operation of an MHR provider

HIPAA – Health Insurance Portability and Accountability Act

ISRP – Individualized Service and Recovery Plan

JCAHO - Joint Commission on Accreditation of Healthcare Organizations


                                          Page 2 of 6                           Section 31.10
LOUISIANA MEDICAID PROGRAM         ISSUED:                                          04/01/09
                                  REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                              PAGE(S) 6

LCSW - Licensed Clinical Social Worker

LMHP - Licensed Mental Health Professional

LOCUS – Level of Care Utilization Scale

LPC – Licensed Professional Counselor

LPN - Licensed Practical Nurse

LRS- Louisiana Rehabilitation Services

MAR – Medication Administration Record

MBHS – Medicaid Behavioral Health Section

Mental Health Related Field – An academic program with a curriculum content in which at
least seventy percent (70%) of the required courses for the major field of study are based upon
the core mental health disciplines.

MHP - Mental Health Professional

MHR - Mental Health Rehabilitation

MHR Facility – a location for services which includes the enrolled site or an off-site used
exclusively for MHR recipients.

MHRSIS - Mental Health Rehabilitation Services Information System

MHS - Mental Health Specialist

NP-Nurse Practitioner

OAD-Office of Addictive Disorders

OCDD-Office of Citizens with Developmental Disorders

OCS – Office of Community Services

OFS – Office of Family Support

OIG – Office of the Inspector General


                                         Page 3 of 6                             Section 31.10
LOUISIANA MEDICAID PROGRAM         ISSUED:                                              04/01/09
                                  REPLACED:                                             06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                                 PAGE(S) 6

OPH – Office of Public Health

Off-site Service Delivery Location - Locations of service that are publicly available and
commonly used by, members of the community other than the provider (e.g. libraries,
community centers, YMCA, church meeting rooms, etc.) and sites or locations that are directly
related to the recipient‘s usual environment, (e.g. home, place of work, school). Other off-site
service locations are those sites or locations that are utilized in a non-routine manner (e.g.
hospital emergency room or any other location in which a crisis intervention service is provided
during the course of the crisis). This can also include a location used solely for the provision of
allowable off-site service delivery by a certified MHR provider.

However, any such location must not be staffed by the provider at times when services are not
being provided, must not house any records of the provider, or be a place where the provider
routinely conducts business but for the allowable off-site service delivery. These locations are
allowed for delivery of the restructured MHR program.

Group counseling and PSR Group shall not be provided at a site that serves as a group living
environment, such as a board and care facility, group home or apartment building that serves as a
residence for more than one MHR recipient.

Medication Management may be provided at the approved provider site or in a recipient‘s natural
environment (schools, home, etc.) as appropriate to recipient needs and circumstances and in
compliance with privacy and confidentiality requirements.

Services may not be provided in an individual practitioner‘s private office. Service may not be
provided in the home of employees or agents of the provider.

On-site – Location of MHR facility that is licensed and certified by the appropriate state agency
or accreditation body to provide specific services.

OSHA – Occupational Safety Health and Administration

Overpayment - Any amount paid by the Bureau to an MHR provider that exceeds the amount
allowed for a service or services furnished under the Medicaid Program. The provider shall
reimburse the Bureau for overpayments.

OJJ -Office of Juvenile Justice Development (formerly Office of Youth Development)

PA – Prior Authorization

PFII – Parent/Family Intervention – Intensive




                                         Page 4 of 6                                Section 31.10
LOUISIANA MEDICAID PROGRAM         ISSUED:                                          04/01/09
                                  REPLACED:                                         06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                              PAGE(S) 6

POC – Plan of Correction

Program Integrity Section – The section of the Bureau responsible for investigating allegations
of fraud and abuse.

Provider Contract – an agreement between the Bureau and a MHR provider.

PSR – Psychosocial Skills Training Group

PSR Models (for Adults) - Boston Psychiatric Rehabilitation Model, Clubhouse Model and
Social Skills Training Model

QMP – Quality Management Program

Recipient – A person who is Medicaid eligible and receiving MHR services

RECON - Reconsideration

Recoupment - The Bureau‘s authority to recover payments made for services that are
subsequently determined not to qualify for reimbursement.

RN – Registered Nurse

Repayment -The MHR provider‘s obligation to refund payments to the Bureau for any claims
that are determined not to qualify for reimbursement

SAA – Service Access and Authorization

SAMHSA - Substance Abuse and Mental Health Services Administration

Service Area - The restricted geographical area delineated by the Bureau in which the MHR
provider may offer services. SMART - Specific, Measurable, Action-Oriented, Realistic and
Time-Limited

SPOE - Single Point of Entry

SRI – Statistical Resources, Inc.

SURS - Surveillance and Utilization Review Section

TB – Tuberculosis

Molina Medicaid Solutions – The agency contracted by the Bureau to act as fiscal intermediary

                                       Page 5 of 6                               Section 31.10
LOUISIANA MEDICAID PROGRAM         ISSUED:                                        04/01/09
                                  REPLACED:                                       06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
SECTION 31.10: ACRONYMS/DEFINITIONS                                            PAGE(S) 6

USPRA - United States Psychiatric Rehabilitation Association

UTOPIA – Utilization, Tracking, Oversight, and Prior Authorization Information System

WRAP – Wellness Recovery Action Plan




                                      Page 6 of 6                              Section 31.10
LOUISIANA MEDICAID PROGRAM       ISSUED:       04/01/09
                                 REPLACED:     06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX A: HARDWARE AND IT REQUIREMENTS     PAGE(S) 1




                      APPENDIX A
                   APPENDIX A
      HARDWARE AND OPERATING SYSTEMS REQUIREMENTS FOR MHRSIS


Agencies must have a PC equipped with a CD-ROM, a minimum of 500 megabytes of RAM (1 gigabyte
preferred), 10/100 Ethernet Network Interface Card (NIC), compatible printer, and Internet connection
(Dial up connection with telephone Modem can work, but a broadband connection using Cable or DSL is
preferred).


Operating System Requirements for MHRSIS


The Operating System(s) required to run MHRSIS include the following:
Microsoft Windows 2000, XP, or Vista
Please note that as of 2007, Microsoft has begun to phase out technical support for Windows 2000.
Users should consider migrating existing workstations from Windows 2000 before Microsoft officially ends
technical support for this Operating System.


Networking Requirements for MHRSIS


Agencies that wish to use multiple PCs to connect to a single instance of the MHRSIS software and data
for a specific clinic must operate the software over a LAN based network. Technical support will not be
provided to agencies that manually copy and move data across PCs to share data and encounter
problems.


Data Back-up and Disaster Recovery


Agencies are responsible for backing up confidential recipient data and MHRSIS data. A copy of the data
should be kept onsite and off-site in a secure location with password protection. In the event of a
computer failure, the MHRSIS contract vendor will charge the provider a fee to recover for each MHRSIS
file. In the event of a disaster, providers must have emergency contact information, treatment records,
etc. If a recipient moves to a different location following a disaster, past treatment information will be
critical to ensure continuity of care.
LOUISIANA MEDICAID PROGRAM        ISSUED:       04/01/09
                                  REPLACED:     06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX B: LETTER OF ATTESTATION             PAGE(S) 2




                      APPENDIX B


                    APPENDIX B
  LETTER OF ATTESTATION OF MEDICAL RECORD DESTRUCTION


    All fields must be completed or claims and letter will be returned without processing.


Provider Name: _____________________________________________

      Due to extenuating circumstances beyond my control, I am unable to provide the requested
       medical documentation in support of my Medicaid claim(s).

      I attest that the medical record documentation was (check only box no. 1 or 2):

       1. [ ] Completely destroyed; or

       2. [ ] Partially destroyed and rendered unreadable and unusable

       on _______________ by the following cause(s) (check all that apply):
                 Date
       [ ] flood
       [ ] fire
       [ ] Hurricane ___________
       [ ] other_____________________________ (please specify).

       If box no. 2 above is checked, I certify that I have subsequently had the medical record documentation
       completely destroyed by using the following method:
       __________________________________________________________________________.

      I certify that the above information is true, accurate, and complete.

      I understand that payment of this claim will be from Federal and State funds, and that any
       falsification, or concealment of a material fact, may be prosecuted under Federal and State laws.

      I certify that I am an owner or an individual legally authorized to act on behalf of the owner(s) or
       providers(s).

_______________________________________________________                    ______________________
Name and Title (please print)                                              Relationship to Provider

______________________________________________________                     __________________
Signature                                                                  Date

______________________________________________________                         ____________________
Provider Name                                                                  Provider Billing Number
Done and signed before the below Notary Public on ______________, 2006.



__________________________________                    __________________________________

Notary Public                                         Witness




      Submitter Medicaid ID Number (if different than billing provider number):   ___________



      Total Number of Claims Submitted with this Letter of Attestation:           ___________



      Total Billed Charges of Claims Submitted with the Letter of Attestation:    ___________



                                              (For internal use only) DHH approval: yes or no
LOUISIANA MEDICAID PROGRAM      ISSUED:        04/01/09
                                REPLACED:      06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX C: DHH RESEARCH POLICY             PAGE(S) 16




                       APPENDIX C


                     APPENDIX C
 POLICY NUMBER:             0021-98

 SUBJECT:                   Departmental Research

 CONTENT:                   Policy and procedures for the protection of human subjects of research
                            projects conducted in facilities and programs operated or funded by the
                            Department of Health and Hospitals

 EFFECTIVE DATE:            Issued:       March 1, 1991 (Office of Human Services Research
                                           Policy)
                            Revised:      March 20, 1998

 INQUIRIES TO:              Office of Management and Finance
                            Division of Research and Development
                            P.O. Box 2870
                            Baton Rouge, LA 70821-2870
                            Telephone: (225) 342-3807         FAX (225) 342-0080




Issued:    March 1, 1991                                                            Policy 0021-98
Revised:   March 20, 1998                                                              Page 0021.1
                         DEPARTMENT OF HEALTH AND HOSPITALS
                              DEPARTMENTAL RESEARCH



 I.     PURPOSE

           These policies are designed to assure the protection of the rights of human subjects of research
           conducted in programs or facilities operated or funded by the Department of Health and Hospitals
           (DHH).

 II.    APPLICABILITY

           These policies apply to all research conducted in programs/facilities operated or funded by the
           DHH.

 III.      DEFINITIONS

           Cognitively Impaired - having either a psychiatric disorder (e.g., psychosis, neurosis, personality or
           behavior disorders), an organic impairment (e.g., dementia) or a developmental disorder (e.g.,
           mental retardation) that affects cognitive or emotional functions to the extent that capacity for
           judgement and reasoning is significantly diminished. Others, including persons under the influence of
           or dependent on drugs or alcohol, those suffering from degenerative diseases affecting the brain,
           terminally ill patients, and persons with severely disabling physical handicaps may also be
           compromised in their ability to make decisions in their best interests.

           Competence - technically, a legal term, used to denote capacity to act on one's own behalf; the
           ability to understand information presented, to appreciate the consequences of acting (or not acting) on
           that information, and to make a choice. (See also: Incompetence, Incapacity.) Competence may
           fluctuate as a function of the natural course of a mental illness, response to treatment, effects of
           medication, general physical health, and other factors. Therefore, mental status should be re-
           evaluated periodically. As a designation of legal status, competence or incompetence pertains to an
           adjudication in court proceedings that a person's abilities are so diminished that his or her
           decisions or actions should have no legal effect. Such adjudications are often determined by
           inability to manage business or monetary affairs and do not necessarily reflect a person's ability to
           function in other situations.

           DHH - Department of Health and Hospitals (Louisiana).

           DHHS - U.S. Department of Health & Human Services. This Federal agency promulgated 45
           CFR, Part 46, Protection of Human Subjects, revised June 18, 1991, effective August 19, 1991.
           DHH's research policies are based upon 45 CFR, Part 46.


Issued:       March 1, 1991                                                                       Policy 0021-98
Revised:      March 20, 1998                                                                         Page 0021.2
           Human Subject - a living individual about whom an investigator (whether professional or student)
           conducting research obtains:

                   1.      data through intervention or interaction with the individual; or

                   2.      identifiable private information.

           Identifiable Private Information - private information includes information about behavior that
           occurs in a context in which an individual can reasonably expect that no observation or recording is
           taking place, and information which has been provided for specific purposes by an individual and which
           the individual can reasonably expect will not be made public (e.g., a medical record). Private
           information must be individually identifiable (i.e., the identification of the subject is or may readily be
           ascertained by the investigator or associated with the information) in order for obtaining the
           information to constitute research involving human subjects.

           Incapacity - refers to a person's mental status and means inability to understand information
           presented, to appreciate the consequences of acting (or not acting) on that information, and to
           make a choice. Often used as a synonym for incompetence.

           Incompetence - technically, a legal term meaning inability to manage one's affairs. Often used as a
           synonym for incapacity.

           IRB Approval - the determination of the IRB that the research has been reviewed and may be
           conducted within the constraints set forth by the IRB and by other State and Federal requirements.

           Institutional Review Board (IRB) - the DHH committee with responsibility for reviewing and
           recommending approval/disapproval of all research proposals.

           Interaction - includes communication or interpersonal contact between investigator and
           subject.

           Intervention - includes both physical procedures by which data are gathered (e.g., venipuncture)
           and manipulations of the subject or his/her environment that are performed for research purposes.

           Investigator - the person conducting research.

           Minimal Risk - the probability and magnitude of harm or discomfort anticipated in the research are not
           greater in and of themselves than those ordinarily encountered in daily life or during the
           performance of routine physical or psychological examinations or tests.




Issued:       March 1, 1991                                                                          Policy 0021-98
Revised:      March 20, 1998                                                                            Page 0021.3
           Programmatic Offices - the major programmatic offices in DHH are: Bureau of Health Services
           Financing (BHSF), Office of Alcohol and Drug Abuse (OADA), Office for Citizens with
           Developmental Disabilities (OCDD), Office of Mental Health (OMH), and Office of Public Health
           (OPH).

           Research - systematic investigation, including research development, testing and evaluation,
           designed to develop or contribute to generalizable knowledge.

 IV.   STATEMENT OF PRINCIPLES

           A.      The DHH believes that research involving human subjects must be based upon the
                   principles of respect for persons, beneficence, and justice.

                   1.      Respect for persons involves a recognition of personal dignity and autonomy of
                           individuals, and special protection of those persons with diminished autonomy.

                   2.      Beneficence entails an obligation to protect persons from harm by maximizing
                           anticipated benefits and minimizing possible risks of harm.

                   3.      Justice requires that benefits and burdens of research be distributed fairly.

           B.      DHH also recognizes that many consumers of its services may be cognitively impaired and
                   therefore deserve special consideration as potential research subjects. The predominant
                   ethical concern in research involving persons with psychiatric, cognitive, developmental,
                   or chemical dependency disorders is that their conditions may compromise their capacity
                   to understand the information presented and their ability to make a reasoned decision
                   about participation. Consequently, approval of proposals to use these individuals as
                   research subjects will be conditioned upon the researcher demonstrating that:

                   1.      such individuals comprise the only appropriate subject population;

                   2.      the research question focuses on an issue unique to these subjects;

                   3.      the research involves no more than minimal risk, except when the purpose of the
                           research is therapeutic for these individual subjects and the risk is commensurate
                           with the degree of expected benefit.




Issued:         March 1, 1991                                                                    Policy 0021-98
Revised:        March 20, 1998                                                                      Page 0021.4
 V.        POLICIES AND PROCEDURES

      A. Policy Basis

                   Research conducted and authorized by the DHH will meet all applicable federal and state
                   laws and regulations, accreditation standards, and professional codes of ethics. These
                   policies derive primarily from 45 CFR, Part 46, Protection of Human Subjects and are
                   also consonant with 21 CFR, Parts 50 and 56, adopted by the Food and Drug
                   Administration. (Both sets of regulations were effective on August 19, 1991.) 45 CFR,
                   Part 46 is applicable to other DHHS components, including the Health Care Financing
                   Authority (Medical Assistance Programs).
           B.      Establishment of Institutional Review Board (IRB)

                   There is hereby established a DHH IRB to review and evaluate all proposed research
                   projects.

                   1.     Twenty-four hour facilities may either utilize these policies as written or amend
                          them to provide for an in-house IRB for initial assessment of research projects
                          prior to submission to the DHH IRB for final review.

                   2.     All research involving DHH consumers, employees, or services in the community
                          and in institutions will be reviewed by the DHH IRB before it is submitted to the
                          Secretary or designee for final approval.

                   3.     The IRB is a permanent standing committee which meets quarterly or as needed.

                   4.     The membership shall consist of at least seven members, appointed by the
                          Secretary, partly from recommendations by the assistant secretaries and the
                          director of the BHSF:

                          a.      The director of Research and Development or his/her designee shall serve
                                  as permanent chairperson of the IRB. In the event of an extended
                                  absence from duty of the permanent chair, the Secretary shall appoint a
                                  temporary replacement to serve during that period;

                          b.      each office and the BHSF shall have at least one member;

                          c.      relevant professional disciplines shall be represented in the membership;

                          d.      at least one member shall be a direct service provider;




Issued:         March 1, 1991                                                                   Policy 0021-98
Revised:        March 20, 1998                                                                     Page 0021.5
                          e.      one member shall not be employed by the DHH. If possible, this member
                                  should be an ethicist (specialist in ethics) or an attorney;

                          f.      at least one member shall be either a primary consumer, or a family
                                  member, or an advocate;

                          g.      at least one member's primary concerns shall be in science areas and at
                                  least one member's primary concerns shall be in non scientific areas. If not
                                  selected under Section V.B.4.e., an attorney or ethicist should fill the latter
                                  slot.

                   5.     The IRB may, in its discretion, invite individuals with competence in special areas to
                          assist in the review of issues which require expertise beyond or in addition to that
                          available to the IRB. Such individuals shall not vote with the IRB.

                   6.     IRB members should have appropriate research training, experience or interest.
                          Membership should also represent sufficiently the cultural, ethnic, and gender
                          diversity of the State and be sensitive to diverse community attitudes.

                   7.     Except for the chair, members shall be appointed for one-year terms and may be
                          reappointed.

                   8.     No IRB member may participate in the initial or continuing review of any project in
                          which the member has a conflicting interest, except to provide information
                          requested by the IRB.

                   9.     Once constituted, the IRB shall adopt written by-laws and guidelines/application
                          materials for conducting research in DHH operated/funded programs or facilities.

                   10.    Research approved by the Office of Public Health's (OPH) IRB prior to the
                          adoption of these policies does not require DHH IRB approval. However, copies of
                          proposals approved by the OPH IRB shall be provided to the chair of the DHH IRB.

           C.      IRB Review Process

                   Prior to authorization and initiation of research, an IRB meeting shall be convened to
                   conduct a detailed review of the project in order to determine that all of the following
                   requirements are met.
                   1.     Proposal incorporates procedures designed to minimize the risk to participants.
                          Risks to subjects are minimized by using procedures which are consistent with
                          sound research design and do not unnecessarily expose subjects to risk and,




Issued:         March 1, 1991                                                                       Policy 0021-98
Revised:        March 20, 1998                                                                         Page 0021.6
                     whenever appropriate, by using procedures already being performed on subjects
                     for diagnostic or treatment purposes.
               2.    Risks to subjects are reasonable in relation to anticipated benefits and the
                     importance of any knowledge that may reasonably be expected to result. In
                     evaluating risks and benefits, the IRB should consider only those risks and benefits
                     that may result from the research, as distinguished from risks and benefits of
                     therapies subjects would receive even if not participating in the research. The IRB
                     should not consider possible long-range effects of applying knowledge gained in
                     the research (e.g., possible effects of research on public policy) as among those
                     research risks that fall within its purview.

              3.     Selection of subjects is equitable. In making this assessment, the IRB should take
                     into account the purposes and setting of the research. It should be particularly
                     cognizant of special problems of research involving vulnerable populations, such
                     as children, prisoners, pregnant women, mentally disabled persons, or
                     economically or educationally disadvantaged persons.

              4.     Research design minimizes possible disruptive effects of project on organizational
                     operation.

              5.     Research design is in compliance with accepted ethical standards.

              6.     Informed consent will be sought from each prospective subject or the subject's
                     legally authorized representative, in accordance with, and to the extent required in
                     Section V.E. of this document.

              7.     Informed consent will be appropriately documented, in accordance with and to the
                     extent required by Section V.E.1 - E.5 of this policy.

              8.     When appropriate, the research plan provides monitoring of the data collected to
                     ensure subjects' safety.

              9.     Research proposal contains requisite safeguards to protect the privacy of subjects
                     and to maintain the confidentiality of data.

              10.    Research proposal has been approved at the appropriate program administrative
                     level, beginning with the program/facility.




Issued:    March 1, 1991                                                                     Policy 0021-98
Revised:   March 20, 1998                                                                       Page 0021.7
           D.      IRB Recommendations and Notification

                   1.     Researchers should be either present at the IRB meeting which considers their
                          proposals or available for questioning at an indicated phone number during that
                          time.

                   2.     Following detailed review, the IRB by majority vote approves (fully or
                          provisionally) or disapproves the research proposal.

                          a.      Provisional approval means that minor modifications, specified in writing
                                  by the IRB, must be received by the chair within 30 days in order to
                                  recommend full approval.

                          b.      Proposals receiving full approval are sent to the Secretary or designee for
                                  authorization to begin research.

                   3.     The Secretary or the director of Research and Development will notify the
                          researcher in writing of the IRB's decision to approve or disapprove the proposed
                          research within 10 working days.

                          a.      If the proposal is not approved, the letter will indicate reasons for
                                  disapproval and give the researcher an opportunity to respond in writing
                                  to the IRB.

                          b.      There are no appeals for research proposals disapproved on the basis of
                                  ethical shortcomings or potential harm to subjects.

                          c.      No research, subject to IRB review, can begin until written authorization
                                  from the Secretary or designee is received.

                          d.      Research approved by the IRB may be subject to further administrative
                                  review and approval or disapproval. However, no administrator can
                                  approve research which has not been approved by the IRB.

                          e.      After approval, the IRB shall review the research in progress at
                                  appropriate intervals, but not less than once per year.

                          f.      The IRB has the authority to suspend or terminate approval of research
                                  that is not being conducted in accordance with the IRB's requirements or
                                  that has been associated with unexpected harm to subjects. Any
                                  suspension or termination of approval shall be in writing, include the
                                  reasons for this action, and be reported promptly to the investigator,
                                  appropriate agency officials, and the Secretary.


Issued:         March 1, 1991                                                                      Policy 0021-98
Revised:        March 20, 1998                                                                        Page 0021.8
                     g.     Cooperative research refers to those projects covered by this policy
                            which involve more than one institution or agency. In the conduct of
                            cooperative research projects, each institution or agency is responsible for
                            safeguarding the rights and welfare of human subjects and for complying
                            with 45 CFR, Part 46. With the approval of the DHH or agency head,
                            an institution participating in a cooperative project may enter into a joint
                            review arrangement, rely upon the review of another qualified IRB, or
                            make similar arrangements for avoiding duplication of effort.

              4.     Expedited Review Procedure

                     a.     Research that involves no more than minimal risk and in which the only
                            involvement of human subjects will be in one or more of the following
                            categories (carried out through standard methods) may be reviewed by
                            the IRB through an expedited review procedure. Under this procedure,
                            the review may be carried out by the IRB chairperson or by one or more
                            experienced reviewers designated by the chair from among IRB members.
                            In reviewing the research, the reviewers may exercise all of the authority
                            of the IRB except that they may not disapprove the research. Research
                            may be disapproved only after review in accordance with the non-
                            expedited procedures set forth in Section V.C. A report of all research
                            approved by expedited review will be presented by the chair to the full
                            IRB at its next regularly scheduled meeting. Categories of research which
                            may qualify for expedited review include:

                            i.      research conducted in established or commonly accepted
                                    educational settings, involving normal educational practices (e.g.,
                                    research on special education instructional strategies);

                            ii.     research involving the use of educational tests, survey procedures,
                                    interview procedures, or observation of public behavior if such
                                    research does not record information or identifiers which can be
                                    linked to individual human subjects;

                            iii.    research involving the collection or study of existing data,
                                    documents, records, pathological specimens, or diagnostic
                                    specimens;

                            iv.     research and demonstration projects which are conducted by or
                                    subject to the approval of the Secretary or heads of programmatic




Issued:    March 1, 1991                                                                      Policy 0021-98
Revised:   March 20, 1998                                                                        Page 0021.9
                                             offices and are designed to study, evaluate, or otherwise examine
                                             public benefit of services or programs.

                                    v.       research conducted by faculty or students at colleges/universities
                                             if all of the following conditions are met:

                                             (a).    a copy of the university's IRB policies is on file with the
                                                       DHH
                                                       IRB;

                                             (b).    university IRB's approval of the research is documented;

                                             (c).    a copy of the full research proposal is included;

                                             (d).    for student research, written approval of the project by
                                                     both a faculty advisor and a DHH staff sponsor must be
                                                     provided;

                                    vi.      research approved by an IRB in 24-hour facilities if requested via
                                             the chief executive officer of the facility to the DHH IRB chair;

                                    vii.     requests from investigators for minor changes in research
                                             approved less than one year prior to such request;

                                    viii.    cooperative research which has been approved by the IRB and
                                             head of an agency outside of DHH.

                           b.       The Secretary or agency heads may restrict, suspend, terminate, or
                                    choose not to authorize use of the expedited review procedure.

           E.      Informed Consent of Research Subjects

                   Except as provided elsewhere in this policy, no investigator may involve a human being as a
                   subject in research unless the investigator obtains the legally effective informed consent of
                   the subject or the subject's legally authorized representative. An investigator shall seek
                   such consent only under circumstances that provide the prospective subject or the
                   representative sufficient opportunity to consider whether or not to participate and that
                   minimize the possibility of coercion or undue influence. The information that is given to the
                   subject or representative shall be in language easily understandable to the subject or
                   representative. No informed consent document may include any exculpatory language
                   through which the subject or representative is made to waive or appear to waive any of the




Issued:         March 1, 1991                                                                         Policy 0021-98
Revised:        March 20, 1998                                                                         Page 0021.10
              subject's legal rights or the investigator, the sponsor, or the agency and its agents
              are/appear to be released from liability for negligence.

              1.     Basic Elements of Informed Consent

                      Except as provided below, the investigator shall provide each subject the following
                      information:

                      a.      a statement that the study involves research, an explanation of the
                              purposes of the research and the expected duration of the subject's
                              participation, a description of the procedures to be followed, and
                              identification of any procedures which are experimental;

                      b.      a description of any reasonably foreseeable risks or discomforts to the
                              subject;

                      c.      a description of any benefits to the subject or to others which may
                              reasonably be expected from the research;

                      d.      a disclosure of appropriate alternative procedures or courses of treatment,
                              if any, that might be advantageous to the subject;

                      e.      a statement describing the extent, if any, to which confidentiality of records
                              identifying the subject will be maintained;

                      f.      for research involving more than minimal risk, explanations as to whether
                              any compensation and medical treatment are available if injury occurs and,
                              if so, what they consist of, or where further information may be obtained;

                      g.      an explanation of whom to contact for answers to pertinent questions
                              about the research and research subjects' rights, and whom to contact in
                              the event of a research related injury to the subject;

                      h.      a statement that participation is voluntary, refusal to participate will involve
                              no penalty or loss of benefits to which the subject is otherwise entitled,
                              and the subject may discontinue participation at any time without penalty
                              or loss of benefits to which the subject is otherwise entitled.

              2.     Additional Elements of Informed Consent

                      When appropriate, one or more of the following elements of information shall also
                      be provided to each subject:



Issued:    March 1, 1991                                                                           Policy 0021-98
Revised:   March 20, 1998                                                                           Page 0021.11
                     a.      a statement that the particular treatment or procedure may involve risk
                             that is currently unforeseeable;

                     b.      anticipated circumstances under which the subject's participation may be
                             terminated by the investigator without regard to the subject's
                             consent;

                     c.      any additional costs to the subject that may result from
                             research participation;

                     d.      the consequences of a subject's decision to withdraw from the research
                             and procedures for orderly termination of participation by the
                             subject;

                     e.      a statement that significant new findings developed during the course of
                             the research which may relate to the subject's willingness to
                             continue participation will be provided to the subject;

                     f.      the approximate number of subjects involved in the study.

              3.     Waiver of Informed Consent

                     The IRB may waive the requirement to obtain informed consent provided that the
                     IRB finds and documents that:

                     a.      the research or demonstration project is to be conducted by or subject
                             to the approval of state government officials and is designed to
                             study or evaluate public benefit of services provided or funded by
                             DHH;

                     b.      such project deals with improving procedures for
                             obtaining benefits/services under those programs and/or suggesting
                             possible changes in or alternatives to those programs/procedures or in
                             the methods/levels of payment for benefits or services under those
                             programs; and

                     c.      such research or projects shall not involve identifying individual
                             recipients of services/benefits.

              4.     Documentation of Informed Consent

                     a.      Informed consent shall be documented by the use of a written
                             consent form approved by the IRB and signed by the subject or
                             the subject's legally authorized representative. A copy shall be
                             given to the person signing the form.
Issued:    March 1, 1991                                                                      Policy 0021-98
Revised:   March 20, 1998                                                                      Page 0021.12
                           b.       The written consent document must embody the elements of
                                    informed consent required in Section V.E.1. This form may be read
                                    to the subject or the subject's legally authorized representative but,
                                    in any event, the investigator shall give either the subject or the
                                    representative adequate opportunity to read it before it is signed. An
                                    IRB recommended informed consent document will be included in
                                    the guidelines/application materials for conducting research in
                                    DHH operated/funded programs or facilities.
                           c.       The IRB may waive the requirement for the investigator to obtain a
                                    signed consent form for some or all subjects if it finds either:

                                    i.      that the only record linking the subject and the research
                                            would be the consent document and the principal risk would
                                            be the potential harm resulting from a breach of
                                            confidentiality. Each subject will be asked if he/she wants
                                            documentation linking him/her with the research, and the
                                            subject's wish shall govern; or

                                    ii.     that the research presents no more than minimal risk of
                                            harm to subjects and involves no procedures for which
                                            written consent is normally required outside of the
                                            research context.

                           d.       In cases in which the documentation requirement is waived, the IRB
                                    may require the investigator to provide subjects with a written
                                    statement regarding the research.

                   5.      The IRB shall demand additional protection and informed consent rights if
                           the research involves fetuses, pregnant women and human in-vitro
                           fertilization (45
                           CFR 46:201-211), prisoners (45 CFR 46:301-306), or children (45 CFR
                           46:401-409).

           F.      Responsibilities of Research Investigators

                   In addition to all of the requirements detailed above, researchers shall be responsible
                   for the following.

                   1.      Research investigators shall prepare and submit a protocol giving a
                           complete description of the proposed research.

                           a.       The protocol shall include provisions for adequate protection of the
                                    rights and welfare of prospective research subjects and ensure that
                                    pertinent laws and regulations are observed.
Issued:         March 1, 1991                                                                         Policy 0021-98
Revised:        March 20, 1998                                                                         Page 0021.13
                      b.     Samples of proposed informed consent forms shall be included with the
                             protocol.

                      c.     A completed DHH Application To Conduct Research must be submitted
                             with the protocol.

              2.     Research investigators shall obtain and document appropriate administrative
                     approval (beginning at the program/facility level) to conduct research before the
                     proposal is submitted to the DHH IRB.

              3.     Prior to the beginning of the research, the investigator shall communicate to
                     impacted staff the purpose and nature of the research.

              4.     Upon completion of the research, the principal investigator shall attempt to remove
                     any confusion, misinformation, stress, physical discomfort, or other harmful
                     consequences, however unlikely, that may have arisen with respect to subjects as
                     a result of the research.

              5.     Within 30 working days of the completion of the research, the principal
                     investigator shall communicate the outcome(s) and practical or theoretical
                     implications of the research project to the program administrator and, when
                     appropriate, program staff in a manner that they can understand.

              6.     The researcher shall submit progress reports as requested by the IRB (at least
                     annually). As soon as practicable after completion of the research, but in no case
                     longer than 90 working days later, the research investigator shall submit to the IRB
                     a written report, which, at a minimum, shall include:

                     a.      a firm date on which a full, final report of research findings will be
                             submitted;

                     b.      a succinct exposition of the hypotheses of the research, the research
                             design and methodologies, and main findings of the research;

                     c.      an estimate of the validity of conclusions reached and some indication of
                             areas requiring additional research; and

                     d.      specific plans for publishing results of the research.

              7.     A final report of the research as well as copies of any publications based upon the
                     research will be submitted to the IRB as soon as possible. The State owns the
                     final report, but prior permission of the IRB for the investigator to publish results



Issued:    March 1, 1991                                                                        Policy 0021-98
Revised:   March 20, 1998                                                                        Page 0021.14
                         of the research is not required. The publication is the property of the researcher
                         and/or the medium in which it is published. However, failure to provide the IRB
                         with required periodic and final reports or publications based on the research shall
                         impact negatively that researcher's future requests to conduct research in DHH
                         operated/funded programs or facilities.

           G.      Initiation of the Research Review Process

                   1.     The first contact in the process should be by the research investigator with
                          the manager of the program or facility from which subjects will be
                          drawn.

                   2.     If the manager agrees that the research is feasible and desirable, the researcher
                          will obtain his/her written authorization and send the protocol to appropriate
                          staff at headquarters for consideration and approval by the assistant
                          secretaries or the director of BHSF.

                   3.     The assistant secretaries or the director of BHSF, in approving the
                          research proposal, will certify that:

                          a.      the research design is adequate and meets acceptable scientific
                                  standards;

                          b.      appropriate ethical considerations have been identified and
                                  discussed;

                          c.      the proposal contains provisions to minimize possible disruptive effects
                                  of the project on organization's operation;

                          d.      the research will potentially benefit the participants directly or improve
                                  the service system; and

                          e.      the research topic is compatible with the agency's research
                                  agenda.

                   4.     The assistant secretaries or the director of BHSF, after approval of the
                          research, will submit the proposal to the IRB for further consideration.

           H.      IRB Records

                   1.     The IRB shall prepare and maintain adequate documentation of IRB
                          activities, including the following:

                          a.      copies of all research proposals reviewed, scientific evaluations, if any,
                                  that accompany the proposals, approved sample consent documents,
Issued:         March 1, 1991                                                                      Policy 0021-98
Revised:        March 20, 1998                                                                        Page 0021.15
                             progress reports submitted by investigators, and reports of injuries to
                             subjects;

                     b.      minutes of IRB meetings in sufficient detail to show attendance at the
                             meeting; actions taken by the IRB; the vote on these actions, including the
                             number of members voting for, against, and abstaining; the basis for
                             requiring changes in or disapproving research; and a written summary of
                             the discussion of controverted issues and their resolution;

                     c.      records of continuing review activities;

                     d.      copies of all correspondence between the IRB and investigators;

                     e.      a list of IRB members identified by name; earned degrees; representative
                             capacity; indications of experience sufficient to describe each member's
                             chief anticipated contributions to IRB deliberations; and any employment
                             or other relationship between each member and DHH;

                     f.      written procedures for the IRB and statements of significant new findings
                             provided to subjects.

              2.     The records required by Section V.H. shall be retained for at least three years,
                     and records relating to research which is conducted shall be retained for at least
                     three years after completion of the research. All records shall be accessible for
                     inspection and copying by authorized representatives of DHHS or the agency at
                     reasonable times and in a reasonable manner.




Issued:    March 1, 1991                                                                      Policy 0021-98
Revised:   March 20, 1998                                                                      Page 0021.16
LOUISIANA MEDICAID PROGRAM      ISSUED:       04/01/09
                                REPLACED:     06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX D: SERVICE LOG                     PAGE(S) 3




                     APPENDIX D


                   APPENDIX D
LOUISIANA MEDICAID PROGRAM        ISSUED:       04/01/09
                                  REPLACED:     06/01/05
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX E: MESSAGE TO EPSDT ELIGIBLES AND
PARENTS                                       PAGE(S) 1




                      APPENDIX C

                      APPENDIX E


                    APPENDIX E
     MESSAGE FOR ALL EPSDT ELIGIBLES AND THEIR PARENTS

KIDMED is a Louisiana Medicaid Program that starts an eligible, Medicaid recipient under 21
years of age on a healthy life by offering preventative care, like regular examinations and
immunizations. Regular examinations may prevent future problems and immunizations will
protect your child from diseases like measles and mumps. If you are a Medicaid recipient or
have a child under the age of 21, you may be eligible for the following services at no cost to you:

Doctor visits; hospital (inpatient and outpatient) services; lab test and x-ray; family planning
services; home health care; dental care; rehabilitation services; prescription drugs; medical
equipment, appliances and supplies (DME); case management; speech and language evaluations
and therapies; occupational therapy; physical therapy; psychological evaluations and therapy;
psychological and behavior services; podiatry services; optometrist services; hospice services;
extended home health services; residential institutional care; home and community based
(waiver) services; medical, dental, vision and hearing screenings, both periodic and inter-
periodic; immunizations; eyeglasses; hearing aids; psychiatric hospital care; personal care
services; audiological services; necessary transportation: ambulance transportation, non-
ambulance transportation; appointment scheduling assistance; chiropractic services; prenatal
care; certified nurse midwives; certified nurse practitioners; mental health rehabilitation; mental
health clinic services; addictive disorder services and any other medically necessary health care,
diagnostic services, treatment, and other measures which are coverable by Medicaid, which
includes a wide range of services not covered for recipients over the age of 21.

For further information regarding available services, or to schedule necessary medical
transportation for your children or yourself (if under 21 years of age), you may contact
KIDMED by calling 1-877-455-9955. To schedule a screening visit, you may contact KIDMED
at 1-800-259-4444 (or 928-9683 if you live in the Baton Rouge area), or by contacting your
physician if you already have a KIDMED provider. If you are deaf or
have a hearing impairment, please call the TTY number, 1-877-544-9544. If you have a
communication disability or are non-English speaking, you may have someone call KIDMED
and the appropriate assistance can be provided.

Some of these services must be approved by Medicaid in advance. Your medical
provider should be aware of which services must be pre-approved and can assist you in obtaining
those services. In addition, KIDMED can assist you or your medical provider with information
as to which services must be pre-approved.

Louisiana Medicaid encourages you to contact the KIDMED office and obtain a KIDMED
provider so that you or your children may be better served.
    LOUISIANA MEDICAID PROGRAM           ISSUED:    03/01/11
                                        REPLACED:
    CHAPTER 31: MENTAL HEALTH REHABILITATION
    APPENDIX F: SAA DOCUMENTS DEFINED             PAGE(S) 3

All forms required for the authorization of Mental Health Rehabilitation services are
defined below. A listing of when the provider must complete and submit these forms
is also provided.

Service Access and Authorization (SAA) Documents Defined:
       1. Assessment Form – comprehensive psychosocial summary submitted to request
           admission to the Mental Health Rehabilitation (MHR) program. This form must
           also be submitted when a person has not received MHR for over 12 months.
       2. Authorization Request Form (ARF) – form that summarizes clinical information
           and is submitted to request prior authorization (PA) of services.
       3. e-CDI - Electronic-Clinical Data Inquiry printout that the treating psychiatrist and
           LMHP must review, sign, and date.
       4. Freedom of Choice Form – list of MHR agencies by parish that recipients review
           and sign indicating which agency they selected as their provider.
       5. Full Packet – includes the Authorization Request Form, the
           assessment/reassessment form, ISRP, e-CDI, and for new cases, the eligibility
           screening forms.
       6. Individual Service and Recovery Plan (ISRP) – form that contains goals,
           objectives and interventions to meet the individualized treatment needs of a
           recipient.
       7. Reassessment Form – form updating the progress/status of a person who has
           been in the MHR program for three months or more.
       8. Request for Revision Form – form completed to request additional services
           before the end of a current PA due to unforeseen circumstances (i.e. crisis)
           during that period.
       9. Request to Override Service Limits – form sent by providers to request approval
           for billing of services that exceed the service limits (services have already
           occurred). Providers must document unforeseen and extraordinary
           circumstances.
       10. Youth/Adult Screening for Medical Necessity Criteria - form completed by
           providers prior to assessment to determine if recipients will meet
           eligibility/medical necessity criteria.

    *The above forms can be found at www.mbhsla.org.




                                             Page 1 of 3                          Appendix F
    LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                        REPLACED:
    CHAPTER 31: MENTAL HEALTH REHABILITATION
    APPENDIX F: SAA DOCUMENTS DEFINED            PAGE(S) 3

Required Documentation Based Upon the Specific SAA Activity:
Phase One: Screening for MHR Eligibility
         - The following document must be completed:
           1. Youth/Adult Screening for Medical Necessity Criteria form

Phase Two: Determining Eligibility and Developing the Initial ISRP
         - For ALL recipients five years and younger AND for new providers until they
           are notified by SAA to discontinue, the following documents must be
           completed and submitted:
           1. Authorization Request Form
           2. Submission of the Screening Form completed in Phase One
           3. Initial Assessment
           4. Initial Individual Service and Recovery Plan
           5. e-CDI
           6. Freedom of Choice
         - For recipients six years and older the above documents must be completed,
           but only the document indicated below must be submitted:
           1. Authorization Request Form

Phase Three: Requesting Continued Services (Reassessment)
          - For ALL recipients five years and younger the following documents must be
             completed and submitted:
             1. Authorization Request Form
             2. Reassessment
             3. Updated Individual Service and Recovery Plan
             4. e-CDI
          - For recipients six years and older the above documents must be completed,
             but only the document indicated below must be submitted:
             1. Authorization Request Form

Request for Reconsideration
          - The following documents must be completed and submitted:
             1. Faxed denial notice or PA notice from MHRSIS with ‘RECON’ written
                across the front in black marker.
             2. Revised Authorization Request Form with any additional
                information/explanation and “Reconsideration” indicated in Section 31.2.




                                            Page 2 of 3                        Appendix F
    LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                        REPLACED:
    CHAPTER 31: MENTAL HEALTH REHABILITATION
    APPENDIX F: SAA DOCUMENTS DEFINED            PAGE(S) 3


Request for Revision
          - The following documents must be completed and submitted:
             1. Request for Revision Form (if more details are needed, SAA may request
                 the full packet of information)

Service Limit Override Request
           - The following documents must be completed and submitted:
              1. Service Override Request Form
              2. CMS 1500 Claim Form
              3. MHR Service Log
              4. Remittance Advice from Molina




                                          Page 3 of 3                       Appendix F
LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                    REPLACED:
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX G: CONTACT/REFERRAL INFORMATION     PAGE(S) 4


                        CONTACT/REFERRAL INFORMATION


               Name of Contact                                Address/Telephone/Website

Fiscal Intermediary: Molina Medicaid Solutions (formerly UNISYS Corporation)
Electronic Media Claims (EMC)                                         P.O. Box 91025
Electronic claims sign up and testing                             Baton Rouge, LA 70898
                                                                   Phone: 225-216-6000
                                                                    Fax: 225-216-6335

Pharmacy Point of Sale (POS)                                           P.O. Box 91019
                                                                  Baton Rouge, LA 70821
                                                               Phone: 800-648-0790 (Toll Free)
                                                                Phone: 225-216-6381 (Local)
                                                                 *After hours please call REVS line
Pre-Certification Unit (Hospital)                                      P.O. Box 14849
Pre-certification issues and forms                              Baton Rouge, LA 70898-4849
                                                                    Phone: 800-877-0666
                                                                     Fax: 800-717-4329

Prior Authorization Unit (PAU)                                       P.O. Box 14919
Prior authorization issues, forms, etc.                          Baton Rouge, LA 70898
                                                            Phone: 800-807-1320 (Home Health)
                                                              Phone: 866-263-6534 (Dental)
                                                          Phone: 800-488-6334 (DME & All Other)

Provider Enrollment Unit (PEU)                                        P.O. Box 80159
Provider Enrollment, direct deposit problems,                     Baton Rouge, LA 70898
reporting of changes and ownership, NPI                            Phone: 225-216-6370
                                                                    Fax: 225-216-6392

Provider Relations (PR)                                               P.O. Box 91024
Billing and training questions                                    Baton Rouge, LA 70821
                                                                Phone: 225-924-5040 (Local)
                                                                  800-473-2783 (Toll Free)
                                                                    Fax: 225-216-6334

Recipient Eligibility Verification (REVS)                      Phone: 800-776-6323 (Toll Free)
                                                                Phone: 225-216-7387 (Local)

Web Technical Support                                         Phone: 877-598-8753 (Toll Free)

                                                Page 1 of 4                                     Appendix G
LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                    REPLACED:
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX G: CONTACT/REFERRAL INFORMATION     PAGE(S) 4


             Name of Contact                              Address/Telephone/Website

Department of Health and Hospitals (DHH)
Division of Administrative Law/HH Section                          P.O. Box 4189
Appeals                                                        Baton Rouge, LA 70821
                                                                Phone: 225-342-0443

Health Standards Section (HHS)                                     P.O. Box 3767
                                                               Baton Rouge, LA 70821
                                                                Phone: 225-342-0138
                                                                 Fax: 225-342-5292

Louisiana Medicaid Website                                    http://www.lamedicaid.com
Provider Web Portal

Louisiana’s Medicaid and Louisiana Children’s        General Medicaid Hotline: 888-342-6207
Health Insurance Program (LaCHIP)
General Medicaid and card questions                        LaCHIP: 225-342-0555 (Local)
                                                         LaCHIP: 877-252-2447 (Toll Free)
                                                     http://bhsfweb.dhh.louisiana.gov/LaCHIP/

Medicaid Behavioral Health Section                                   P.O. Box 91030
Service Access and Authorization (SAA)                      Baton Rouge, LA 70821-9030
Quality Management (QM)                                          Phone: 225-342-1203
Network Services (NS)                                     Fax: 225-342-1972 or 225-342-1973
Member Services (MS)                                         Toll-free fax: 1-866-427-2148
                                                                http://www.mbhsla.org
                                                   * See MBHS website for additional contact information.

Office of Aging and Adult Services (OAAS)                         P.O. Box 2031
                                                             Baton Rouge, LA 70821
                                                              Phone: 866-758-5035
                                                               Fax: 225-219-0202
                                                           E-mail: MedWeb@dhh.la.gov
                                                   http://www.dhh.louisiana.gov/offices/?ID=105

Office for Citizens with Developmental                          628 N. Fourth Street
Disabilities (OCDD)                                          Baton Rouge, LA 70802
                                                          Phone: 866-783-5553 (Toll Free)
                                                             E-mail: ocddinfo@la.gov
                                                   http://www.dhh.louisiana.gov/offices/?ID=191



                                            Page 2 of 4                                    Appendix G
LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                    REPLACED:
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX G: CONTACT/REFERRAL INFORMATION     PAGE(S) 4


             Name of Contact                                 Address/Telephone/Website

Department of Health and Hospitals (DHH)
Office of Management and Finance (Bureau of                         P.O. Box 91030
Health Services Financing) MEDICAID                             Baton Rouge, LA 70810
                                                       http://www.dhh.louisiana.gov/offices/?ID=92

Program Integrity (PI)                                               P.O. Box 91030
                                                                Baton Rouge, LA 70810
                                                                    Fax: 225-219-4155
                                                         Fraud and Abuse Hotline: 800-488-2917
                                                              http://www.dhh.louisiana.gov

Rate and Audit (R&A)                                                 P.O. Box 546
                                                              Baton Rouge, LA 70821-0546
                                                                  Phone: 225-342-6116
                                                                   Fax: 225-342-1834
                                                      http://www.dhh.louisiana.gov/offices/?ID=111

Recipient Assistance for Authorized Services                         1-888-758-2220

Substance Abuse and Mental Health Services                        http://www.samhsa.gov
Administration

Take Charge (Family Planning Waiver)                                P.O. Box 91278
                                                                Baton Rouge, LA 70821
                                                                 Phone: (888) 342-6207
                                                                  Fax: (877) 523-2987
                                                                    medweb@la.gov
                                                             www.takecharge.dhh.louisiana.gov

Third Party Liability (TPL)                                          P.O. Box 91030
TPL Recovery, Trauma                                              Baton Rouge, LA 70802
                                                                   Phone: 225-342-8662




                                               Page 3 of 4                             Appendix G
LOUISIANA MEDICAID PROGRAM           ISSUED:   03/01/11
                                    REPLACED:
CHAPTER 31: MENTAL HEALTH REHABILITATION
APPENDIX G: CONTACT/REFERRAL INFORMATION     PAGE(S) 4


             Name of Contact                               Address/Telephone/Website

Other Helpful Contact Information
Centers for Medicare and Medicaid Services                         www.cms.hhs.gov
(CMS) OASIS, CMS-485 Form

Office of Emergency Preparedness                    http://gohsep.la.gov/plans/modelhmhlthpln.htm
Home Health Emergency Model Plan

Office of Population Affairs (OPA)                                   P.O. Box 30686
Clearinghouse                                                  Bethesda, MD 20824-0686
                                                                  Phone: 866-640-7827
                                                                   Fax: 866-592-3299
                                                           E-mail: Info@OPAclearinghouse.org

Superintendent of Documents                                          P.O. Box 371954
To obtain current CMS-1500, UB-04, ADA claim                   Pittsburgh, PA 15250-7954
forms                                                             Phone: 202-512-1800




                                             Page 4 of 4                              Appendix G

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:8
posted:9/21/2011
language:English
pages:153